EmailMe Form - Army ROTC Questionnaire

How did you hear about our program? *

Name *

First Last

Email *

Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Phone *

### - ### - ####

Date of Birth *

MM / DD / YYYY

Birth Place *

City, State, Country

Are you a U.S. citizen? *

Yes

No

Marital Status *

Number of Children.
(Max of 3 dependents, including spouse.) *

Academic Information

Have you been accepted to Georgia Southern? *

Yes - Already enrolled

Yes - But not yet enrolled

No - Have not applied

No - Have applied and awaiting acceptance

At which campus are you interested in pursuing ROTC? (Select all that apply.) *

Statesboro

Armstrong

Savannah State University

Eagle ID, if applicable.

High School Attended *

High School GPA *

Graduation Year

SAT Math Score *

SAT Critical Reading Score *

ACT Score *

Did you participate in JROTC? *

Yes

No

If YES, please list branch and number of years you participated.

College Hours Completed *

Academic Major *

College GPA *

Incoming Freshmen

Would you like to live with other ROTC Cadets in Southern Pines (Georgia Southern - Statesboro campus only)? *

Yes

No

Maybe

Medical and Criminal History

Height (in) and Weight (lbs)

Please list any prescription medications, past hospitalizations, allergies, asthma, broken bones, surgical procedures, academic accommodations, etc. *

Have you used drugs? *

Yes

No

Please list any past law violations including tickets of $250 and above or any civil convictions. *

Prior Service

Are you prior service? *

Yes

No

MOS

RE Code

Army National Guard Unit

Army Reserve Unit

Comments

Please include any sports, other extra curricular activities, awards, and any additional information or questions