Contact Army ROTC


ROTC Information Request Form

* First Name:

* Last Name:

Date of Birth:

* Address (street, PO box, city, state, and zip):

* Phone Number:     Cell Phone:

* Email:

Classification:

Major:

GPA:

Are you currently in high school?   Yes     No

If you answered "Yes" to the previous question, then where?

Marital Status:   Married     Not Married

Are you in good physical shape?   Yes     No

Please explain your physical shape:

Do you have any prior military service?   Yes     No

Please describe any prior military service:

Additional Comments:

*required field