Forms needed for Enrollment

Form required in order to enroll in the program

 

Forms

Descriptions

Remarks

Directions

1

139 R

Cadet Enrollment Record

Must be typed; fill out pages 1 and 2 only.  

       

Additional Documentation and Forms to be hand-carried to NCO

2 DA Form 3425-R Physical Exam Form Must be filled out by a Doctor, PA or Nurse.  Can be hand-written and scanned.
       
3 CC Form 136-R Briefing on Government Sponsored Benefits Can be hand-written, print it out, sign/date.
       
4 CC Form 137-R Authorization for Access to Student Records Part one must be signed to access your transcripts and to speak with your parents about your academics.  Type in your name, school, and parent's names then print it out, sign/date. **IF YOU DO NOT WISH FOR US TO SPEAK WITH YOUR PARENTS - SIGN/DATE PART II.
       
5 CC Form 104-R Planned Academic Worksheet This is your planned academic worksheet. Working through this sheet with your academic counselor will help ensure you graduate on time. This is not a requirement for New Cadet Orientation -- you will complete when you arrive on campus prior to contracting. 
       
6 DD Form 93 Record of Emergency Data Must be typed, sign in block #15.  Do not fill in block #16.  Cadre will do that on campus.  
       
7 DD Form 2005 (2017) Privacy Act Statement Health Care Records Can be hand-written, print it out, sign/date.
       
8 Proof of Health Insurance ID Card or Paperwork Copied and returned to student immediately.
       
9 Transcripts High School and/or College Unofficial is acceptable; must have name/address on form. 
       
10

Contracting Memorandum Of Understanding

Contracting Memorandum of Understanding

Print, initial and sign.

       
11 DD Form 2058 State of Legal Residence Can be hand-written, print it out, sign/date.
       
12 SGLV 8286 Service Member's Group Life Insurance Form Must be typed, print it out, sign/date.
       
13 SF 1199A Direct Deposit Form

Must be typed, print it out, sign/date, leave section 2 blank, ***AND bank must fill out section 3.

       
14

W-4 2022

 

Tax Form Must be typed, print it out, sign/date.
       
15

SSN Card and Photo ID or Driver's License 

Must be original

Copied and returned to student immediately.
       
16

Dental Record Memo

Statement of Acknowledgement

This form is to confirm the existence of dental records.  Can be hand-written. No need to make a dental appointment.

       
17

Birth Certificate

Must be original or certified copy

Copied and returned to student immediately. 

       
18

Standardized Test Scores

Documentation from ACT or SAT Unofficial is acceptable; must have name/address on form.

The following are copies of ROTC Contracts and Security Clearance Forms

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19 SF-86 Security Clearance Questionnaire Do Not fill out
       

20

DD Form 4  

Enlistment Document

Do Not fill out

 

 

 

 

21

DA Form 597

ROTC Scholarship Cadet Contract

Do Not fill out