Scholarship Questionnaire

If you are interested in receiving additional information about Army ROTC, please complete this form and press the "Submit" button.  Please use your mouse or keyboard "Tab" key to move between fields.  Do not press your keyboard "Enter" key until you are ready to submit the form.  Privacy Act Notice:  Disclosure of the information requested below is voluntary.  All information will be used strictly for recruiting purposes.  The authority for the collection of this information is Title 10, United States Code, Section 503.

Name:              Graduation Year:

E-mail Address:

Street Address:

City  State or US Territory   Zip Code: 

Social Security#:    Phone Number:

SAT/ACT Score:    GPA:

High School:

College Interested in:

(1)

(2)

(3)

Expected Major:

Please Send Me More Information on:

ROTC Program

Science and Engineering

ROTC Scholarship Application

Nursing Program

 


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