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(Waiver approval is not guaranteed).º Enrollment Eligibility Officer: Verify the criteria below and sign the certification on page 5. (Scholarship students must also meet scholarship eligibility requirements in Part VII)  55. PREVIOUS CRITERIAµWaiver Required (Prior to Contracting): Age 35 or older at time of commissioning. Brigade Commander can waive thru age 39. CG is waiver approval authority for over 39 years of age.>Waiver Required: Pending waiver for criteria in Part V above.+Waiver Granted (Eligible): Date,Ineligible (Waiver denied or nonwaiverable). 56. CIVIL CONVICTION»Eligible: (a) No civil conviction, adverse adjudication, or court-martial conviction other than minor traffic violations (Exception: alcohol-related driving offenses) resulting in a finej expunged, sealed, set aside, dismissed, or original finding or pleas changed still require a waiver.SX GFor use of this form, see CC Pam 145-4, the proponent agency is ATCC-PCIneligible (Waiver denied or nonwaiverable): (a) Pending charges for violating any civil law; (b) On supervised and/or conditional probation. 57. DEPENDENCY¹Eligible: (a) Single student with no dependents. (b) Married student with no more than three (3) dependents, to include spouse. (c) Single student whose children have been placed by ¶y court order in the custody of an adult relative/legal guardian and the student is not required to pay child support. ´ court order in the custody of an adult relative/legal guardian when the student is required to pay child support. (c) Spouse is also in Army ROTC and there are children under Ÿ 18 years old. (d) Spouse is in a military component of any Armed Service (other than Inactive Ready Reserve) when student has a child under 18 years old. CC Form 139-R, DEC 2007Ineligible (Waiver denied or nonwaiverable): Single parents who have legal custody of their children who are under 18 years old. Page 3 of 6ÃEligible: Registered for and attending full time (in accordance with university policy - usually 12 or more credit hours) a regular course of instruction resulting in an accredited undergraduatefEligible: Student meets criteria 49-54 on the Basic Course Enrollment Eligibility Checklist (Part V).¸Waiver Required (Prior to Contracting): (a) More than three (3) dependents (spouse plus more than 2 children under 18 years old). (b) Single parent whose children have been placed by¶I ALL NON-SCHOLARSHIP CADETS MUST MEET THE FOLLOWING CRITERIA TO CONTRACT:U 1. To record necessary information for entering a Cadet into the CCIMS database.5 2. To create a legal record of Cadet enrollment.¿ entry into the Basic Course. A Cadet will not be contracted until he/she has completed, signed, and initialed this form and the Enrollment Eligibility Officer certifies by signature that the# Cadet is eligible for contracting.… Cadre will verify that the information on this form is current and accurate during each required periodic counseling with the Cadet.³ This form will be retained in the Cadet's MPRJ as a permanent document and retained with the Cadet Record Brief for five years following the Cadet's appointment or disenrollment._Basic Course Enrollment Eligibility (Noncontracted Cadets): See notes/instructions for Part V.Õ(6) Medical: AR 145-1, Ch 3; CC Pam 145-4; AR 40-29; AR 40-501, Ch 2. Height and weight standards for prior service Cadets are found in AR 600-9. Height and weight standards for non-prior service Cadets are foundt(10) Physical Fitness: AR 145-1, Ch 3; CC Reg 145-1; Cc Pam 145-4; Cadet scholarship and non-scholarship contracts.Ù(11) Medical: AR 145-1, Ch 3; Cc Pam 145-4; AR 40-29; AR 40-501, Ch 2. Height and weight standards for prior service Cadets are found in AR 600-9. Height and weight standards for non-prior service Cadets are found inØ(2) Medical: AR 145-1, Ch 3; Cc Pam 145-4; AR 40-29; AR 40-501, Ch 2. Height and weight standards for prior service Cadets are found in AR 600-9. Height and weight standards for non-prior service Cadets are found ins(8) Physical Fitness: AR 145-1, Ch 3; CC Reg 145-1; CC Pam 145-4; Cadet scholarship and non-scholarship contracts.CC Form 139-R, DEC 07¹ Enrollment Eligibility Officer: Verify the criteria below and sign the certification on page 5. (Scholarship students must also meet scholarship eligibility requirements in Part VII.) 58. SUBSTANCE ABUSE·Eligible: (a) Never used chemical substances or drugs; (b) Self admitted limited, experimental use of chemical substances or drugs which occurred over 6 months prior to contracting,0 unless disqualified by DoDMERB.c frequent and/or habitual use of chemical substances or drugs prior to contracting. 59. LOYALTY OATH&Eligible: Cadet signed loyalty oath. *Ineligible: Refuses to sign loyalty oath. 60. PRIOR SERVICE²Eligible: (a) No prior service. (b) Honorably discharged from the Armed Services with a qualifying RE code of 1 on DD Form 214. (c) Currently in the Army Reserve or National  Guard (see NOTE below).WWaiver Required: (a) Honorably discharged with an RE code other than 1 on DD Form 214.ºIneligible (Waiver denied or nonwaiverable): (a) Honorably discharged with a disqualifying RE code on the DD From 214. (b) More than ten (10) years Active Duty, without an exception toº policy from CC. (c) Any type of discharge other than "honorable". (d) Current or former commissioned officer, or has a certificate of eligibility for appointment as a commissioned 61. CITIZENSHIP.Ineligible (Nonwaiverable): Non-U.S. citizen. 62. PLACEMENT CREDIT 63. ACADEMIC STATUS²Eligible: (a) All students must be enrolled full time AND academically aligned AND have a cumulative college GPA (if any) of 2.0 on a 4.0 scale or equivalent. (b) MJC freshman ^ also require at least a 2.0 cumulative high school GPA AND SAT score of 850 or ACT of 17.TWaiver Required: Graduate student with less than full time enrollment (waiverable).¬Ineligible (Waiver denied): (a) Student is not academically aligned (Exceptions to policy may be considered); (b) Cumulative college GPA is less than 2.0 (nonwaiverable). 64. PHYSICAL FITNESSREligible: Score 180, with a minimum of 60 points in each event, on a single APFT.aWaiver Required: Student is medically disqualified by a DoDMERB or MEPS physical, if applicable.BIneligible (Nonwaiverable): Failure to meet eligibility criteria. 65. MEDICALFEligible: Student is fully medically qualified by a DoDMERB physical. 66. AGE|Eligible: Student is at least 17 years of age at time of contracting and will be less than age 30 at time of commissioning.? NOTE: Retirement benefits are at risk for 33 and higher.  `Ineligible (Waiver denied or nonwaiverable): Student is younger than 17 at time of contracting.,PART VII - SCHOLARSHIP ELIGIBILITY CHECKLISTºWaiver Required: (a) Self admitted use of chemical substances or drugs on an experimental or limited basis, which occurred within six (6) months prior to contracting. (b) Self admitted Page 4 of 6E ALL SCHOLARSHIP CADETS MUST MEET THE FOLLOWING CRITERIA TO CONTRACT:í Enrollment Eligibility Officer: Verify the criteria below and sign the certification on page 5. Scholarship students must also meet scholarship eligibility requirements. NOTE: Green to Gold scholarship applicants must meet additional ­² X criteria in order to apply. Refer to the current Green to Gold application for details. 67. PREVIOUS CRITERIAJIneligible: Ineligible for contracting unless student is fully qualified. 68. MEDICAL< ;Eligible: Student is fully medically qualified by DoDMERB.?Waiver Required: Student is medically disqualified by DoDMERB. 69. MAJOR®Eligible: U.S. citizen. (Dual citizens must renounce foreign citizenship prior to receiving a clearance, which is a prequisite for commissioning (see CC PAM 145-4, 2-39a)).©Eligible: U.S. Citizen (Must be verified per instructions). (Dual citizens must renounce foreign citizenship prior to receiving a clearance (see CC PAM 145-4, 2-39a)).Æ for enrollment refer to AR 145-1, Ch 3, and CC Pam 145-4). Dual citizenship-foreign citizenship must be renounced prior to receipt of a clearance, which is a prerequisite for commissioning. KEligible: Student is majoring in one of the majors listed in CC Reg 145-1.VWaiver Required: Student is not majoring in one of the majors listed in CC Reg 145-1.Ineligible (Waiver denied). 70. AGEºEligible: Student must be 17 years of age within the first semester following award of the scholarship (cannot contract until reaches age 17) and be under 31 years of age on 31 December* of the calendar year of commissioning. 71. ACADEMIC STATUS²Eligible: Score of 180 with 60 points in each event on a single APFT. NOTE: All scholarship applicants must be given a physical assessment (APFT or PFT) during the face-to-face GL ¯ interview for assessment of physical ability. The APFT must be passed NLT 15 Dec (or NLT 1 May for mid-term entries) at the 60/60/60 - 180 standard prior to contracting.£®µEligible: Student must meet ALL THREE of the following criteria: (a) Academically aligned. (b) Cumulative college GPA of 2.5 on a 4.0 scale, OR student has no college GPA yet, but has a cumulative high school GPA of 2.5 on a 4.0 scale. (c) Full time student (in accordance with university policy - usually 12 or more credit hours).HS GPAOR College GPA»Waiver Required: (a) Student has a cumulative college GPA of less than 2.5 on a 4.0 scale. Rounding is not permitted. (b) Student has no cumulative college GPA yet, but has a cumulativep high school GPA of less than 2.5 on a 4.0 scale. (c) Graduate student who is enrolled less than full time. 72. ACT/SATU of less than $250. (b) Not guilty verdict or successful appeal of a conviction.µ resulting in a fine of less than $250. Any conviction resulting in other adverse dispositions (punishment other than a fine) requires a waiver. Convictions where the record is¸Eligible: (a) Two-year scholarship recipient: no requirement (except two-year MJC). (b) Two-year MJC, three-year or four-year scholarship recipient with composite ACT score of 19 or6 greater OR composite SAT score of 920 or greater.SCORE: SAT VerbalSAT Math ACT CompositeŸWaiver Required: Two-year MJC, three-year or four-year scholarship recipient with composite ACT score of less than 19 OR composite SAT score of less than 920.‹Ineligible (Waiver denied or nonwaiverable): Two-year MJC, three-year or four-year scholarship applicant who has not taken the ACT or SAT. 73. ACADEMIC CREDITS* 7 semesters/10-11 quarters remaining.ñ violations (Exception: alcohol-related driving offenses) which involved a fine or forfeiture, alone, of less than $250. I have not had 6 or more minor traffic violations (excluding parking violations) in a 12-month period where the fine is:PART VI - NONSCHOLARSHIP CONTRACTING ELIGIBILITY CHECKLISTH ALL NONSCHOLARSHIP CADETS MUST MEET THE FOLLOWING CRITERIA TO CONTRACT:LNonscholarship Contracting Eligibility: See notes/instructions for Part VI.± If a waiver is required, refer to the current "Approval Authority/Flow of Cadet Actions" matrix and CC Pam 145-4, or other published guidance for current processing of waivers.“ Reproduction of this form on cardstock for durability is recommended. You may fill in permanent information in ink and changeable items in pencil.BWaiver Required: If the student does not meet the criteria above. 74. PHYSICAL FITNESSAIneligible (Nonwaiverable): Failure to meet eligibility criteria.,PART VIII - ENROLLMENT OFFICER CERTIFICATION, Certify by signature as many as applicable:XBASIC COURSE: Student is eligible (fully or by waiver) for entry into the Basic Course. Name/Rank: Signature:Date:^SCHOLARSHIP: Student is eligible (fully or by waiver) to contract as a scholarship recipient. Page 1 of 6ÂWaiver Required (Prior to Contracting): Any civil conviction, adverse adjudication, or court-martial conviction other than minor traffic violations (Exception: Alcohol-related driving offenses)EPART VI - NONSCHOLARSIP CONTRACTING ELIGIBILITY CHECKLIST (CONTINUED)ZNONSCHOLARSHIP: Student is eligible (fully or by waiver) to contract as a nonscholarship. Page 5 of 6%Instructions and Notes (CC Pam 145-4)I The purpose of the Cadet Enrollment Record (CC Form 139-R) is threefold: ‚ 3. To guide the Enrollment Eligibility Officer through the process of determining eligibility for enrollment and contracting.à A student is not enrolled in Army ROTC until he/she has completed, signed, and initialed this form and the Enrollment Eligibility Officer certifies by signature that the student is eligible for q Contracting any student is subject to the approval of the PMS, even when all other eligibility criteria are met. Notes and references: Part I-IIIqHeight and weight is approximate. Fully discuss with the student any physical conditions they identify in Part I. Part IV×(a) Emphasize that the student is only signing that he/she has read and understands the Homosexual Conduct Policy Briefing. They are not making any statement about their sexual orientation by signing that statement. Part V3(1) Academic Status: AR 145-1, Ch 3; CC Pam 145-4.;(2) Conscientious Objection: AR 145-1, Ch 3; CC Reg 145-1.-(3) Character: AR 145-1, Ch 3; CC Pam 145-4.ƒ(4) Tattoos: AR 670-1, dtd 1 Jul 02, para 1-8e, TRADOC MSG dtd 011525Z, Subj: TRADOC/USAREC IET RECRUIT/CADET TATTOO/BRAND POLICYâ(5) Citizenship: Must be verified. The following documents may be used in verifying U.S. Citizenship: (a) Birth Certificate, (b) Certificate of Naturalization, (c) Certificate of Naturalization of parents, (d) INS From N-560 Part VIn(1) Basic Course Eligibility Requirements: Cadet must meet basic course eligibility requirements - (1) - (6).W(2) Civil Conviction: AR 145-1, Ch3; CC Reg 145-1; CC Pam 145-4; and AR 601-210, Ch 4.%(3) Major: CC Reg 145-1, Appendix F.\ Born Overseas With U.S. Parents )Dual Citizenship (See CC PAM 145-4, 2-39)Ø(3) Dependency: AR 145-1, Ch 3; CC Pam 145-4. In questions of custody, only court orders are acceptable. Powers of Attorney have no binding legal effect in such cases. Cadre will not counsel or advise sole parentÀ Do not ask about a student's sexual orientation. (b) Signing the Loyalty Oath is optional for noncontracted students enrolling in the Basic Course. Aliens do not sign the Loyalty Oath.¸Eligible: Student is enrolling in the Alternate Entry Program, the Accelerated Cadet Commissioning Training Program, OR student has received credit for MS I & MS II by any combinationv x à (Certificate of Citizenship, (e) Department of State Form 1350 (Certificate of Birth Abroad of a Citizen of the U.S.A.), (f) FS Form 240 (Report of Birth, Child Born Abroad of American Parent or Parents), (g) FS Form ² of the following (as set forth in CC Reg 145-3, Table 6-1): (a) Completed Basic Course. (b) Successfully completed LTC. (c) Completed Basic Training in one of the Armed µ Services. (d) Credit for Senior ROTC training (Army, Navy, Air Force, Marine, or Coast Guard). The first year of any SROTC = credit for MS I. Any additional years of SROTC = ¼ credit for the Basic Course. (e) Participation in a service academy. One year = credit for MS I. Two years = credit for the Basic Course. (f) JROTC experience. One year = no credit.n Two years = PMS may award up to MS I credit. Three years = PMS may award up to full Basic Course credi< t.UI have read and understand the briefing concerning the DoD Homosexual Conduct Policy."I am not a conscientious objector.I am a conscientious objector.kEligible: Student does not have any tattoos specifically prohibited by Army policy (see ineligible below).ŒApproval Required: (a) Immigrant Alien (b) Refugee (NOTE: Aliens are ineligible for scholarship and SMP, even if approved for enrollment).ë placed on probation, paroled, or pardoned (to include alcohol violations and misdemeanors), except for minor traffic violations as defined above. I will advise the Professor of Military Science of any future information pertaining to æ any changes of criminal conduct against myself and I shall do so as soon as practical under the circumstances. Records that are expunged, sealed, set aside, dismissed, or original findings or pleas changed STILL require a waiver.ÏÔ ‹Ineligible (Waiver denied or nonwaiverable) Chemical substance or drug abuse requiring professional care, which is medically disqualifying.~ officer. (e) On Active Duty at time of contracting. A soldier on terminal leave is ineligible until actual separation. ~¬ sign an SMP contract (and remain a member of the USAR or ARNG) or sever ties with their USAR or ARNG unit (the ROTC contract overrides any reserve component contract).ß NOTE: Contracted cadets cannot be in the USAR or ARNG (to include IRR) outside of the SMP program. Upon contracting, current members of the USAR or ARNG must either sign an SMP contract (and remain a member of the USAR £ © .Ineligible (Waiver denied/Nonimmigrant Aliens)¸Eligible: (a) Four-year and three-year scholarship winners must meet criteria 55-61 on the Advanced Course Eligibility Checklist (Part VI). (b) Two-year scholarship winners must meetä 545 (Certification of Birth Abroad of a Citizen of the U.S.A.), (h) Unexpired fully valid US Passport issued in the name of the applicant. AR 145-1, Ch 3; CC Reg 145-1 (for scholarship; CC Pam 145-4 (for processing aliensA for enrollment refer to AR 145-1, Ch 3, and CC Pam 145-4).% in AR 40-501 and CC Pam 145-4.k applicants to turn over legal custody; they may only advise on eligibility standards IAW Army policy.3(4) Substance Abuse: AR 145-1, Ch 3; CC Pam 145-4.q(5) Loyalty Oath: Statutory: DoD Dir 1215.8; AR 145-1, Ch 3; CC Pam 145-4. Aliens specifically exempted by law.â(7) Citizenship: Must be verified. The following documents may be used in verifying U.S. Citizenship: (a) Birth Certificate, (b) Certificate of Naturalization, (c) Certificate of Naturalization of parents, (d) INS From N-5604(8) Placement Credit: AR 145-1, Ch 3; CC Reg 145-1.&(9) Academic Alignment: CC Pam 145-4.B(12) Age: Statutory: AR 145-1, Ch 3; CC Reg 145-1; CC Pam 145-4. Part VIIRScholarship Contracting Eligibility. See notes/instructions for Parts VI and VII.w(1) Basic Contracting Eligibility Requirements: Cadet must meet basic contracting eligibility requirements in Part VI.3(4) Age: Statutory: AR 145-1, Ch 3; CC Reg 145-1.(5) GPA: CC Reg 145-1.(6) SAT/ACT: CC Reg 145-1.$(7) Academic Credits: CC Reg 145-1. Page 6 of 6…(6) Prior Service: AR 145-1, Ch 3; CC Reg 145-1; CC Pam 145-4; AR 601-210, Table 3-6 contains RE codes and their eligibility status.Å AR 40-501 and CC Pam 145-4. Female students who are pregnant are ineligible to contract, but regain eligibility at the end of the pregnancy. Pregnancy after enrollment is not a disqualifier.Ÿ criteria 55-62 on the Advanced Course Eligibility Checklist (Part VI). (NOTE: Alternate Entry Option students are ineligible for scholarship).Y^ nIneligible (Statutory-Nonwaiverable): Student exceeds the statutory maximum age requirement IAW CC Reg 145-1.»Eligible: At the time the scholarship begins, (a) Two-year scholarship recipients must have at least 4 semester/6 quarters remaining. (b) 2 1/2-year scholarship recipients must have at³ least 5 semester/7-8 quarters remaining. (c) Three-year scholarship recipients must have 6 semesters/9 quarters remaining, or (d) 3 1/2-year scholarship recipients must haveÎ Recruiting Command. This is done because the Active Army, Army Reserve, and National Guard want and need intelligent young men and women. They also have programs which might help you return to college. Thed I have read and understand the above statement concerning data required by the Privacy Act of 1974.ê an accurate or truthful response is grounds for barring entry into the SROTC program or for the initiation of disenrollment action. Your signature at the bottom of this page will attest to the accuracy of your responses on this form.ä $100 or more per offense. I have not had 12 or more minor traffic violations (excluding parking violations) during the previous 3 years where the fine is $100 or more per offense. I have never been convicted, fined, imprisoned, 45. RELIGIOUS ACCOMMODATION 46. CONSCIENTIOUS OBJECTIONà Although you have not been asked nor will you be asked about your sexual orientation, you should be aware of the DoD Homosexual Conduct Policy. Homosexual conduct is grounds for barring entry or continued enrollment in the 37. ROTC SCHOLARSHIP RECIPIENTCADET ENROLLMENT RECORD(DATA REQUIRED BY THE PRIVACY ACT OF 1974 Authority Principal Purpose(s)210 USC 2101, 2103, 2104, 2107, 2111, and 5 USC 301ÇTo obtain personnel data in order to determine eligibility for enrollment and serve as a source document for cadet's service record throughout participation in the ROTC Program. Provides data for thedadministration of the ROTC student commencing with application for enrollment into the ROTC Program. Routine UsesÁTo verify eligibility to participate in the ROTC Program; to provide information on addresses and telephone numbers for use in the event of death, injury, illness or unauthorized absence while Ëparticipating in ROTC activities; to facilitate contact with complete information with a cadet during other than normal training periods; to make a matter of record the information provided by the cadet. DisclosurešDisclosure is voluntary. However, failure to provide complete information and provide responses will suspend the enrollment process into the ROTC Program.PART I - GENERAL INFORMATION 1. NAME 2. SSN 3. COLLEGE ID # 4. EMAIL 5. LOCAL ADDRESS 5a. CITY 5b. STATE 5c. ZIP CODE 6. PHONE NUM 7. PERMANENT ADDRESS 7a. CITY 7b. STATE 7c. ZIP CODE 8. PH NUM 9. DOB 10. POB 11. RELIGIOUS PREF 12. BLOOD TYPE 13. ACT 14. SAT 15. SEX 16. HEIGHT 17. WEIGHT 18. MARITAL STATUS 19. DEPENDENTS 19a. NUMBER OF DEPENDENTS  20. RACE/ETHNICITY (Check One)  Other Hispanic Caucasian Asian American Indian African American 21. CITIZENSHIP (Check One) U.S. Citizen: U.S. Born NaturalizedNon U.S. Citizen: Immigrant Alien Nonimmigrant Alien Refugeez 22. Do you have any condition that could interfere with you participating in a normal college physical education course? 22a. If "yes" explainI 23. Have you ever received Medical Disability payments from any source? 23a. If "yes" explain 24. NEXT OF KIN 24b. PHONE NO 24a. ADDRESSPART II - ACADEMIC INFORMATION 25. ROTC HOST SCHOOL25a. FICE CODE26. SCHOOL OF ATTENDANCE26a. FICE CODE 27. RESIDENCY STATUS28. ACADEMIC CLASS29. PROJECTED GRADUATION DATE30. ACADEMIC MAJOR 31. ACADEMIC MINOR32. CREDITS TOWARD DEGREE33. CREDITS REQUIRED FOR DEGREE34. CGPA (COLLEGE) 35. OTHER COLLEGES ATTENDED35a. YEAR(S) ATTENDED36. HIGH SCHOOL ATTENDED 36a. GRADUATION DATE37a. If "yes" what type? 38. OTHER SCHOLARSHIPS39. JROTC EXPERIENCETPART III - CURRENT OR PRIOR MILITARY SERVICE (TO INCLUDE OFFICER PRODUCING PROGRAMS)NOT APPLICABLE (Go to PART IV)&Are you currently in the Armed Forces?40a. If "yes" which Branch?40. CURRENT SERVICE: 40b. SMP UNIT<40c. Is your spouse currently a member of the Armed Forces? 41. PRIOR SERVICE:<*<Have you ever been enrolled in an officer producing program?541a. Were you ever disenrolled from the ROTC Program?3 41b. Were you ever enrolled in a Service Academy?441c. Were you ever discharged from the Armed Forces?%41d. If "yes" what type of discharge?#41e. If "yes" what was the RE Code? 41f. Months of Active Service741g. Have you ever been discharged for medical reasons?41 h. If "yes", explain:3REPLACES ALL PREVIOUS EDITIONS, WHICH ARE OBSOLETE. Last NameSSNPART IV - STUDENT STATEMENTS 42. RELEASE OF INFORMATIONÛ The Privacy Act requires that we notify you of other routine uses of the information we collect from you. You should know that if you leave school, we might provide your name, address, and phone number to the U.S. Armyã transfer of information to the Recruiting Command means that, if you drop from school, you may receive information in the mail or be called by an Army Recruiter. You are under no obligation to accept the mail or to talk to the recruiter.ð Verification of the following statements is required in order to assist in establishing eligibility to participate in the ROTC program. Failure to provide a response will preclude further processing as an enrolled cadet. Failure to provideH 43. STATEMENT OF CRIMINAL PROCEEDINGS BY CIVIL OR MILITARY AUTHORITIESç I have not been indicted or summoned into court under civilian or military law as a defendant in a criminal proceeding, to include any and all proceedings involving juvenile or adult criminal offenses, but excluding minor traffic Check One:The above statement is true.*The above statement is not true - Explain: 44. SUBSTANCE ABUSE Check One:/I have never used an illegal substance or drug.QI have used illegal substances or drugs only on an experimental or limited basis.When: How Often:EI have been a recent or frequent user of illegal substances or drugs.T NOTE: Any future drug use will be grounds for disenrollment from the ROTC Program.Ý The U.S. Army cannot guarantee that my religious practices will be accommodated. I acknowledge and understand that it is the Department of the Army's policy to accommodate religious practices as long as the practice willÝ not have an adverse impact on military readiness, unit cohesion, standards, health, safety or discipline. I further acknowledge and understand that the U.S. Army has the right to amend or eliminate any such accommodation based on the needs of the Army.bI have read and understand the above statement concerning accommodation of my religious practices.Ú If you have moral convictions that preclude you from bearing firearms and/or participating in full military service with the U.S. Army, to include armed combat, then you are a conscientious objector. AR 600-43 defines§ conscientious objection as "A firm, fixed and sincere objection to participation in war in any form or the bearing of arms, because of religious training and belief."Explain:, 47. DOD HOMOSEXUAL CONDUCT POLICY BRIEFINGÕ SROTC Program. Homosexual conduct is a homosexual act, a statement that demonstrates a propensity or intent to engage in homosexual acts, or a homosexual marriage or attempted marriage. A homosexual act means anyÛ bodily contact, actively undertaken or passively permitted, between members of the same sex for the purpose of satisfying sexual desires and any bodily contact that a reasonable person would understand to demonstrate a/ propensity or intent to engage in such an act.l I understand I will be disenrolled from the SROTC Program if one or more of the following findings is made:s a. I have engaged in, have attempted to engage in, or have solicited another to engage in homosexual act or acts.c b. I have made a statement that demonstrates a propensity or intent to engage in homosexual acts.M c. I have married or attempted to marry a person of the same sex as myself. FOR ENROLLMENT OFFICER USE:£Ask the following questions to ensure the applicant understands this policy and expand on the policy, as necessary: (1) Do you fully understand the DoD Homosexual_ Conduct Policy briefing you have read? (2) Do you have any questions concerning this policy?N "All information given on this form is correct to the best of my knowledge."SIGNATURE OF CADET6 48. LOYALTY OATH (OPTIONAL FOR NONCONTRACTED CADETS)ê " I do solemnly swear (or affirm) that I will support and defend the Constitution of the United States of America against all enemies, both foreign and domestic; that I will bear true faith and allegiance to the same, and that I take_ this obligation freely, without any mental reservation or purpose of evasion, so help me God." SIGNATURE OF CADETDATE Page 2 of 6} CADET ENROLLMENT RECORD7PART V - BASIC COURSE ENROLLMENT ELIGIBILITY CHECKLIST*Y ALL NONCONTRACTED CADETS MUST MEET THE FOLLOWING CRITERIA TO ENROLL IN THE BASIC COURSE:a Enrollment Eligibility Officer: Verify the criteria below and sign the certification on page 5. 49. ACADEMIC STATUSD or graduate degree at a host or partnership school.ˆIneligible (Waiver denied): Not registered for and attending full time a regular course of instruction at a host or partnership school. 50. CONSCIENTIOUS OBJECTION´Eligible: (a) U.S. Citizen and is not a conscientious objector. (b) Enrolled alien student (exempt by statute). (c) Students required by their school to take military training. ¼Ineligible: Student is a U.S. Citizen and a conscientious objector at a school, which does not require its students to take military training. (NOTE: Prior to enrollment students who haveÅ previously been conscientious objectors must furnish a letter stating they no longer have convictions that preclude bearing arms and participating in full military service with the U.S. Army). 51. CHARACTERBEligible: Good moral character. No domestic violence conviction.PIneligible: Nonwaiverable. Domestic violence misdemeanor or felony conviction. 52. TATTOOS¾Ineligible: (a) Any tattoo/brand on the face, neck or head (permanent facial makeup that conforms to AR 670-1 makeup standards is permitted). (b) Other tattoos/brands that are visible and¡ that detract from a soldierly appearance while wearing the Class A uniform. (c) Other tattoos/brands that are prejudicial to good order and discipline. 53. CITIZENSHIP!Ineligible: Nonimmigrant Aliens.)Approval Granted (Eligible): Date 54. MEDICAL«Eligible: DA Form 3425-R has been completed and signed by a qualified medical physician (or equivalent statement from university health care provider) showing no medical Q condition/physical impairment that precludes enrollment in the basic course.ÿ‚c $ÍQ!ú%Ä ä(–-?‚/+ˆ21Ž57•7>~:Ù=_8A¾C ™F ôIziKï‰M6P¼4Sº[Vá"[„å_G¼c •f÷ 4i–En§pj¥st}tòup¦uCv¥wáGx©y{@z¢¥{è³|öê€-ö9Ç… x‰»ú‹=ŽÓ<’‰”Ìccò ÒÍÉÀ >”›°­½  dü©ñÒMbP?_*+‚€%´Áƒ„&'(Ð?)Ð?M\\CCMONPS01P\PA_HP4050_05Ü4Cÿ€ê odXXLetter ÿÿÿÿDINU"4êqWI ¡"dXXà?à?U} ¶} m} $} ’} #¶} $$¶} %$ >%%ÿ%ÿ%ÿ%´%´%´%´%´%´ %ð %<@ %Þ@ %´@ %Þ@%´@%Þ@%´@%Þ@%´@%Þ@%´@%Þ@%´@%Þ@%f@%Þ@%´@%Þ@%Þ@%´@%Þ@%´@ý ‰Ó¾NŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠŠ‹Œ$ý  ¾NŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽŽ$ý ‘Ô¾N’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’“”$ý #Õ¾$$$$ý $×¾D$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$%$ý #Ö¾$$$$ý $ؾD$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$%$¾&$$$$ý $Ù¾D$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$%$ý #Ú¾$$$$ý $Û¾D$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$%$¾&$$$$ý $ܾD$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$%$ý 'ݾý Þ¾D($ý ‘ß¾N ’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’—$¾P )   *$ý +ྠ$chhhecheche ý `á¾ …p™†ý `â¾ ……pxqý `ã¾ `chhhhhhhhe,$¾P -.•––––––––.........••••..••••••••••,$ý ˆä¾ nnnchhhhhhhe ý Zå¾ Ychhheý `æ¾ nKý Zç¾ nncheý `è¾ nnpxxq,$¾P]```````````````````````````````````a$ý ˆé¾nnn…chhhhhhe ý  Zê¾Ychhheý `ë¾ncidý Zì¾YYcheý `í¾ …pxxq$¾P]```````````````````````````````````a$ý ]î¾ `pqý Zï¾Zchechh‡chheý Zð¾ZZZchheý `ñ¾ ``Ký Zò¾ zMý  Zó¾!Zpq,$¾P]```````````````````````````````````a$ý ]ô¾ `1ý `õ¾ `p†ý Zö¾YYpq/ ý  Z÷¾ZZZK‚ný Zø¾ZZZL.ý Zù¾ZZZZZpq``a$¾P]```````````````````````````````````a$ý ]ú¾……………1ý ]¾``1 ý  ]ÿ¾ ``a1ý ƒþ¾ „1ý ]ý¾ `a1ý ]ü¾ no1ý ]û¾nchhhhe,$¾P]```````````````````````````````````a$ý ]¾``````ý `¾ `a1 ý  ]¾  `a1ý ]¾ `a1ý ]œ¾^^^^^_1ý `¾````````a$¾P]```````````````````````````````````a$¾]``````ý `¾``aO ý  ]¾ ``aOý ]¾```aOý ]¾ ````````````a$¾Puvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvw$ý ] ¾,`````````````````a1ý b ¾&ZZZ|}}}}}}}}}}~,$¾P]``````````````````````a€€€€€€€€€€$¾P]nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnno$ý ] ¾```````````1 ý  b ¾4ZZZchhhhhhhhhhhhhhhhhe,$¾P]```````````````````````````````````a$×D”l```vvjvjv`T¢T¸T¸TÎTÎTäTÎT¬TvTTv %Þ@!%<@"%ð@#%<@$%Þ@%%´@&%Þ@'%´@(%Þ@)%´@*%Þ@+%´@,%Þ@-%´@.%Þ@/%<@0%ð@1%<@2%Þ@3%´@4%Þ@5%´@6%Þ@7%´@8%Þ@9%´@:%Þ@;%´<%‹@=%ÿ@ý ] ¾ `aciiiiiiiid ý b¾& z{yhhhhhhhhhhhheý Z¾ Yfpxxq$¾P!VWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWj$ý "r¾N"ssssssssssssssssssssssssssssssssssst$¾P#uvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvw$ý $]¾$```achhhhhhe ý $ Z¾$YYpqý $Z¾ $ZZZZZchhhhhheý $ Z¾$!Yfpq$¾P%]```````````````````````````````````a$ý &]¾&````1ý &b¾&YYYf1 ý & b¾& nnnnnnopqý &b¾"&ZZZnchhhhhhhhe$¾P']```````````````````````````````````a$ý (]¾(``achhhhhhe ý ( b¾( ZZZZZpqý (Z¾(ZZZZZZpqý (Z¾(ZZZpq.,$¾P)]```````````````````````````````````a$ý *]¾&*`````achhhhhhhheý *b¾*ZZZZ2ý *b¾ *ZZZZZchhhhhhe$¾P+]```````````````````````````````````a$ý ,] ¾,```apqý ,bÒ¾,nnnnnnnnno3ý ,b!¾(,nnnnnnochhhhhhhe,$¾P-]```````````````````````````````````a$ý .]"¾2.```achhhhhhhhhhhhhhhheý .b#¾ .ZZZgchhhhhhe,$¾P/VWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWj$ý 0k$¾N0lllllllllllllllllllllllllllllllllllm$¾P1]```````````````````````````````````a$¾ 2-1ý 2]%¾2``````ý 2 Z(¾2 ZZZZ ý 2Z&¾2ZZZZZg1ý 2b'¾"2ZZZZchhhhhhhe,$¾P3]```````````````````````````````````a$ý 4])¾64``chhhhhhhhhhhhhhhhhhhidý 4Z*¾4ZZZZZZZZg1,$¾P5]```````````````````````````````````a$ý 6]+¾ 6```ý 6Z,¾6ZZZZZZZZZ1ý 6b-¾06ZZZZZZZZZ1]`````````a$¾P7]```````````````````````````````````a$ý 8].¾8```````a1 ý 8 b/¾8 ZZZZZZZZ1ý 8b0¾8ZZZZZcdý 8Z1¾8YYYYfce,$¾P9]```````````````````````````````````a$ý :]2¾:```a1ý :b3¾:YYYYYYYYY1ý :b4¾,:ZZZ[\\\\\\\\\\\\\Xa$¾P;]````````````````````STTTTTTTTTTTTTUa$¾P<VWWWWWWWWWWWWWWWWWWWWWQQQQQQQQQQQQQQR$ý =!&=Ný = 5ý = ˜‚¾=!˜˜˜"$×@&DŒT`T¢T¢T¢TŒTŒTvT`T¬TvTŒT¢TŒTT>¶@$å‚°== #$ #    !$ #$$$   #    $ $        $  "# $ !$$ !"$$  #  $$   # $ #!!$""$ ##$$   !$  ))$$$ $$$$ $$$$%%$&&&& &&&& &&$$#$$$ "$$&&$''$(( (((( (((((((( ((!"**++$,,,,,,#,,******$**,,--$....#....//$11$00$222222#22 2233$44"444455$6666 6666$77$88 888888"#88!8899$:::::::;#;<<<$:;$$  ï7²ùÿÿÿÿG¾” EEnter your Social Security Number without the dashes; i.e., 000000000%This field is 9 characters in length.   ¾] 8Enter the Local street address where student is located.0000  ¾4 Enter the city.t dr ¾ @Enter the 2 character state abbreviation; i.e., VA, DE, NC, etc.%This field is 2 characters in length.th  ¾³ €Enter the 9 character zip code (if not known, enter the 5 character zip code) do not include the dash; i.e., 123456789 or 12345.   ¾Û ‹Enter your local phone number do not include special characters such as dashes or parenthesis. Do include your area code; i.e., 7577884444.&This field is 10 characters in length.    #¾> Enter your EMail address.o t  #¾m HEnter ONLY if this number is different than your Social Security Number. opa ¾a <Enter the student's permanent home of record street address.umr. ¾h CEnter the city. If an overseas APO address, be sure to include APO.¾å ÀEnter the 2 character state abbreviation; i.e., VA, DE, NC, etc. If an APO address be sure to include AE, AP, etc. If a country, enter country name; i.e., Canada, Germany, Virgin Islands, etc. #¾ ÜEnter your permanent phone number do not include special characters such as dashes or parenthesis. DO include your area code; i.e., 7577884444. If an overseas number be sure to include country code; i.e., 01106221123256. !$¾° aEnter the student's date of birth as DDMMYY. Do not include any special characters; i.e., 311286.%This field is 6 characters in length.44 a¾O *Enter the student's LAST Name; i.e., Jonesnoin ¾P +Enter the student's FIRST Name; i.e., Paulaon  ¾P +Enter the student's MIDDLE Name; i.e., Maryon ¾R -Enter the place of birth CITY; i.e., St Louis¾o JEnter the student's place of birth COUNTY; i.e., Baltimore, Hamilton, etc.rsi. ¾… `Enter the student's place of birth 2-character STATE or COUNTRY; i.e., VA, Canada, Germany, etc.isie ¾“ nEnter the student's Religious Preference, denomination or religion; i.e., Baptist, Southern Baptist, Catholic.ac¾\ 7Enter the student's blood type; i.e., A+, B-, AB+, etc.ign;¾Ä uEnter the student's 2-character ACT COMPOSITE score (this is the composite score for all 4 areas); i.e., 24, 32, etc.%This field is 2-characters in length.be¾š oEnter the student's SAT COMPOSITE score (this is the combined score for verbal and math); i.e. 1200, 950, etc. % f"#¾ƒ 0Enter either M for Male or F for Female; i.e., M)This field is only 1-character in length. 195¾‡ 8Enter the student's height in inches; i.e., 60, 72, etc.%This field is 2-characters in length.¾d 9Enter the student's weight in pounds; i.e., 96, 250, etc. fis ¾Å wIf the student has dependents enter Y for yes and if then complete item #19a. If the student has no dependents enter N.$This field is 1-character in length.e¾¡ SEnter one of the following: M - Married, D - Divorced, S - Single, or W - Widowed.$This field is 1-character in length.isd ¾â ”If the student has dependents enter Y for yes and complete item #19a. If the student has no dependents enter N for no and DO NOT complete item #19a.$This field is 1-character in length.tre;¾¨ }If the student has dependents enter the number of dependents. Be sure to include spouse as a dependent; i.e., 1, 3, 10, etc.mpit !¾j EIf the race/ethnicity is not listed, list it here; i.e., Latino, etc.ncde#¾¯ $This field is 1-character in length.it;     ¾¥ WEnter Y for yes and complete item #22a or enter N for no and DO NOT complete item #22a.$This field is 1-character in length.¾¥ WEnter Y for yes and complete item #23a or enter N for no and DO NOT complete item #23a.$This field is 1-character in length. ¾Ž iEnter Next of Kin's Last Name, First Name, Middle Initial and Relationship; i.e., Jones, Pamela D. Motherct i ¾› vEnter the Next of Kin's Address; include street, city, state and zip code; i.e., 000 Anyplace Street Anytown, NY 12345 ¾Õ °Enter the Next of Kin's phone number; include the area code and do not inlcude any special characters. If overseas, include country code; i.e., 7571234567, 01162212345689. etc.ng. !$¾t OEnter the ROTC HOST school name; i.e., Univ of Pittsburgh, NC A&T College, etc.ecl $$ ¾¨ TEnter the 6-character FICE Code for the ROTC HOST School; i.e., 003714, 010364, etc.*This field is only 6-characters in length. ci.$$¾ ZEnter the SCHOOL OF ATTENDANCE school name; i.e., Univ of Pittsburgh, NC A&T College, etc.d o$$¾¬ XEnter the 6-character FICE Code for the SCHOOL OF ATTENDANCE; i.e., 003714, 010364, etc.*This field is only 6-characters in length.$$#$¾„ 1Enter an R for resident or an N for non-resident.)This field is only 1-character in length. fis&&¾² ^Enter one of the following: FR - Freshman SO - Sophomore JR - Junior SR - Senior GR - Graduate*This field is only 2-characters in length.$&& ¾¼ mEnter the student's projected graduation date as DDMMYY. Do not include any special characters; i.e., 300605.%This field is 6 characters in length. &&¾ jList the major as stated in the college catalogue and enter the code; i.e., Business ´ºÓêÖ±²¥ 0023, etc.Th f&&$¾L 'Enter the academic minor if applicable.og a(( ¾z OEnter the total credits granted towards the attempted degree; i.e., 6, 12, etc.Maen((¾‹ `Enter the total number of credits required to complete the attempted degree; i.e., 128, 60, etc.((¾› vEnter the college cumulative grade point average (CGPA) if applicable; i.e., 3.6, 2.5, etc. Include the decimal point.ch((!"¾z UEnter the college/university name and state of any other college/university attended. Ilu**¾ bIf student attended other college/university, enter the number of years attended; i.e., 3, 2, etc. p**¾ kEnter the Name, city and state of the high school the student attended; i.e., Morgan HS Morgantown VA, etc.***$¾¾ oEnter the student's high school graduation date as DDMMYY. Do not include any special characters; i.e., 170603.%This field is 6 characters in length.,,¾à If student is an ROTC Scholarship Recipient enter a Y for yes and complete item #37a; if not, enter a N for no and DO NOT complete item #37a.)This field is only 1-character in length.!,,¾Ó ®Enter the number of years for the scholarship followed by what type (High School, Campus Based, LTC, GRFD, Green to Gold); i.e., 4-Year High School, 3-Year Campus Based, etc.ng.,,#¾w $If applicable enter an X in the box.)This field is only 1-character in length.CaBa22¾û ¨If you are currently in the service, enter a Y for yes and complete item #40a. If you are not currently in the service, enter a N for no and DO NOT complete item #40a.)This field is only 1-character in length.2322¾¡ |If you are currently in the service, enter the branch; i.e., Army, Air Force, Marines, Navy, Active Reserve, National Guard. f n22#¾† aEnter the SMP Unit Name, Address and Phone Number; i.e., A Btry 1/11th FA Hampton, VA 7578251111er, 44¾¼ iIf your spouse is currently a member of the Armed Services, enter a Y for yes. If not, enter a N for no.)This field is only 1-character in length.mpit44##¾Å rIf you have been ever been enrolled in an officer producing program, enter a Y for yes. If not, enter a N for no.)This field is only 1-character in length.466¾´ aIf you were ever disenrolled from the ROTC Program, enter a Y for yes. If not, enter a N for no.)This field is only 1-character in length.ct l66¾Ø …If you have been ever been enrolled in a Service Academy (West Point, Annapolis, etc.), enter a Y for yes. If not, enter a N for no.)This field is only 1-character in length.nl88 ¾ÿ ¬If you have been ever discharged from the Armed Forces, enter a Y for yes and complete items #41d and 41e. If not, enter a N for no and DO NOT complete items #41d and 41e.)This field is only 1-character in length.88¾½ ’Enter one of the following: HD - Honorable Discharge OTHD - Other Than Honorable Discharge BCD - Bad Conduct Discharge DD - Dishonorable Discharge i#488¾~ YGet this data from Block 27 of DD Form 214; enter the 2-character code; i.e. 3A, 4R, etc.- d 88"#¾o DEnter the number of months served on Active Duty; i.e., 36, 48, etc.e.4R::¾é –If you have ever been discharged for medical reasons, enter a Y for yes and complete item #41h. If not enter a N for no and DO NOT complete item #41h.)This field is only 1-character in length.cher::¾Î ©Enter which branch of JROTC the student participated in, Army, Navy, Air Forces, Marines, and the number of years spent in JROTC; i.e., Army 4 years, Navy 3 years, etc.hact..#¾– qEnter a brief explanation. This field will only hold 2 lines of text; be sure to limit your comments to 2 lines. iJR#¾Å  If you were ever discharged for medical reason, enter a brief explanation; this field will only hold 2 lines of text; be sure to limit your comments to 2 lines.tc:;#ggÿÿÿÿ@ ÒÍÉÀ B ó¨´ž  dü©ñÒMbP?_*+‚€%´Áƒ„&Ð?'Ð?(Ð?)Ð?M\\CCMONPS01P\PA_HP4050_05Ü4Cÿ€ê odXXLetter ÿÿÿÿDINU"4êqWI ¡"dXXà?à?U} #¶} $$¶} %$ B%%ÿ%ÿ%ÿ%´%´%´%´%´%Þ@ %<@ %Þ@ %´@ %<@ %´@%Þ@%´@%Þ@%´@%Þ@%‹@%Þ@%Þ@%f@%Þ@%Þ@%O@%Þ@%O@%Þ@%´@%<@%Þ@ý ®e¾:¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯¯ý «6¾ ¬­¥!þZ À¾¦¦¦¦¦§$¾F°±±±±±±±±±±±±±±±±±±±±±±±±±±QQQQQý  7!¨Ä¤ýZ À¾ "©©ª$ý ‘8¾N’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’’“”$ý u9¾Nvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvw$ý ]:¾N```````````````````````````````````a$ý ]˾N```````````````````````````````````a$ý ];¾N```````````````````````````````````a$ý ]<¾N```````````````````````````````````a$¾ -1ý ]̾J`````````````````````````````````a$¾P VWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWWj$ý u=¾N vvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvvw$ý ];N 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