Writing a Cover Letter to a Prospect Employer

Document Sample
Writing a Cover Letter to a Prospect Employer Powered By Docstoc
					                                                                                PROSPECT/CADET INFORMATION
     ROTC School:        Stephen F. Austin State University                     School of Attendance:                                                                              Host FICE Code:                 003624
                                                                             P.O. Box 13059, SFA Station                                                                       Nacogdoches TX                            75962
                                                                                                   (Street1)                                     (Street2)                                           (State)        (Zip)
                                           Name:                                                                                                                                 SSN:
                                                                           (Last)                                      (First)                        (Middle)                                            (xxx-xx-xxx)
                                           Campaign:                                                        Contact Established:
                                                                    (See Note at bottom of sheet)                                                      (NRL/Target List/CCMIS Schlr/Walk In/Referral-Who Referred)
                                           Local Address:                                                                                                                    Local Phone #:
                                                                                       (Street)                    (City)              (State)      (Zip)                                                    (xxx) xxx-xxxx
                                           Email Address:                                                                                                                      Cell Phone #:
                                                                                                                                                                                                             (xxx) xxx-xxxx
                                           Permanent Address:                                                                                                       Permanent Phone #:
                                                                                       (Street)                    (City)              (State)      (Zip)                                                    (xxx) xxx-xxxx
                                              Sex:                         Height:                         Weight:                               Hair Color:                                        Eye Color:
                                                         (M/F)                         (inches)                             (lbs)                                               (color)                                       (color)
                                           Student ID:                                                                   Religious Pref:                                                  Blood Type:
                                                                        (If different from SSN)                                                    (Denomination or Religion)                                   (A/B/O,Pos/Neg)
                                           Date of Birth:                                                                 Place of Birth:
                                                                  month/day/full year                                                                             (City)                             (County)                     (State)
                                            Marital Status:                                       Dependents:                           How Many:                              Spouse member of armed forces:                           N
                                                                 (S/M/D/W)                                                  (Y/N)                           (#)                                                                    (Y/N)
Race/Ethnicity:                 African American                  Citizenship:                    US Born                          Academic Discipline Mix:                                                ADM1
Check One                       American Indian                   Check One                       Naturalized                      Check One                                                               ADM2
                                Asian                                                             Born overseas to US parents                                                                              ADM3
                                Caucasian                                                         Immigrant alien                                                                                          ADM4
                                Hispanic                                                          Non immigrant alien                                                                                      ADM5
                                Other:                                                            Refugee                    Dual Citizenship
                                                                PHYSICAL / MEDICAL INFORMATION
Condition that interferes with participation in normal physical ed course       N           Asthma:                                                                         Allergies:         N     On Meds:             N
                                                                                                               (Y/N)                                    (Y/N)                             (Y/N)                          (Y/N)
             If Y, explain:
Ever received medical disability payments from any source
                                                                                        (Y/N)
               If Y, explain:
                                                                                 ACADEMIC INFORMATION
College Major:                                                          College Minor:                                                                  SAT:                                       ACT:
                                 (per course catalog)                                                            (per course catalog)
Academic Standing:                               Years of College:                                College GPA:                             Proj Grad Date:                                           Resident:
                           (FR/SO/JR/SR/GR)                                                                             (4.0 scale)                                         (day/month/year)                             (R/N)
Credits earned towards degree:                             Other College attended:
                                              (#)                                                                                                       (name/state)                                                              (Years)
High School Attended:                                                                                                                      HS GPA:                  Date Graduated from HS:
                                                                    (name/city/state)                                                                (4.0 scale)                                                (day/month/year)
                                                                                      SCHOLARSHIP INFORMATION
ROTC Scholarship Recipient:                              What Type:                                                                              Mission Set Awarded In:
                                             (Y/N)                              (# of years, CBSP/LTC/GRFD/GTG/Ded ARNG)
Other Scholarship
                                                                                                           (Name and benefits of scholarship):
                                                                          LATERAL ENTRY INFORMATION
JROTC Experience:                                       If Y, type JROTC program and number of years:
                                  (Y/N)
In the Armed Forces (incl ARNG/USAR):                                      What branch:                                                 Unit:
                                                         (Y/N)                                                                                                                  (Name/Address/Phone #)
Ever discharged from the Armed Forces:                                     What branch:                                                   Type Discharge:                                            RE Code:
                                                         (Y/N)                                                                                                             (HN/OTHD/CBD/DD)                              (See DD 214)
Months Active Service:                                  Ever medically discharged:                              If Y explain:
                                   (#)                                                             (Y/N)
Ever enrolled in an officer producing program:                                      If Y, which one:
                                                                   (Y/N)
Ever enrolled in a service academy:                                                 If Y, which one:
                                                         (Y/N)
Ever disenrolled from an officer producing program:                                       If yes, where:
                                                                                     SCHOLAR / ATHLETE / LEADER
                                                                                                                                                                     University
               GPA>3.0 & SAT/ACT > 1100/21                                              3.4                                           Academic Honors Program designee
               Top 10% class & SAT/ACT > 1100/21                                                                                      Top third of class & GPA > 3.0
     S         Honors/Advanced Placement Program Grad                                                                  S              Top third of class & & SAT/ACT > 1100/21 (Fresh/G2G)
               Membership in National Honors Society                                                                                  GPA>3.0 & SAT/ACT > 1100/21 (Fresh/G2G)
               Valedictorian/Salutatorian                                                                                             ADM 3, 4 or 5
               Varsity Letter                                                                                                         Member intramural team
     A         Member city/regional/competitive league
                                                                                                                       A
                                                                                                                                      Member city/regional/competitive league
               Member organized team/individual sport                                                                                 Member organized team/individual sport
               Elected member of student organization                                                                                 Member of university sports program
               Captain of athletic team                                                                                               Elected member of student organization
     L         Eagle Scout/Gold Star                                                                                                  Captain of athletic team
               Position of responsibility in club/organization                                                         L              Eagle Scout/Gold Star
                                                                                                                                      Position of responsibility in club/organization
Lettered in Band, Position of of Responsibility: Drum Major                                                                           Owns/runs own business or in supervisory position
                 **Note: Campaign types are - High School, Incoming Freshmen, Lateral Entry, Progression, LTC/AEO/ACCT, Green-to-Gold
                                                        Enrollment Forms




CC FORM 139-R           CADET ENROLLMENT RECORD
CC FORM 104-R           PLANNED ACADEMIC WORKSHEET
CC FORM 136-R           BRIEFING ON GOVERNMENT BENEFITS FOR ROTC CADETS
CC FORM 137-R           AUTHORIZATION/DECLINATION FOR ACCESS TO STUDENT RECORDS
DA FORM 3425            MEDICAL FITNESS STATEMENT FOR ENROLLING INTO THE ROTC BASIC COURSE

ID Tags - Req'd for all cadets (next to last form)
Memo - Dental Form Last Form on spreadsheet

DD93
DD2005
DD2058
SGLV8296
SF1199

This form was updated 1 July 2009 to include the newest 139-R (it autopopulates).
The DD 93 is broken into two pages, and they do NOT autopopulate. Still, having it in xls format allows you to print it off without leavin

Enjoy!

JG, WIU




                                                          Page 1 of 60
                                                                 Enrollment Forms




Still, having it in xls format allows you to print it off without leaving the workbook.




                                                                   Page 2 of 60
                                                                                                     CADET ENROLLMENT RECORD
                                                                                For use of this form, see CC Pam 145-4, the proponent agency is ATCC-PC
                                                                                           DATA REQUIRED BY THE PRIVACY ACT OF 1974
Authority                         10 USC 2101, 2103, 2104, 2107, 2111, and 5 USC 301
Principal Purpose(s)              To 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 the
                                  administration of the ROTC student commencing with application for enrollment into the ROTC Program.
Routine Uses                      To 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
                                  participating 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.
Disclosure                        Disclosure 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)                   African American                  American Indian                     Asian                Caucasian                       Hispanic                    Other

21. CITIZENSHIP (Check One)                     U.S. Citizen:               U.S. Born                   Naturalized                 Born Overseas With U.S. Parents                             Dual Citizenship (See CC PAM 145-4, 2-39)

                                                Non U.S. Citizen:                  Immigrant Alien                     Nonimmigrant Alien                          Refugee

22. Do you have any condition that could interfere with you participating in a normal college physical education course?              N             22a. If "yes" explain



23. Have you ever received Medical Disability payments from any source?                        23a. If "yes" explain

24. NEXT OF KIN                                                                            24a. ADDRESS                                                                                                              24b. PHONE NO

                                                                                                     PART II - ACADEMIC INFORMATION
25. ROTC HOST SCHOOL              Stephen F. Austin State University                      25a. FICE CODE 003624                     26. SCHOOL OF ATTENDANCE                                                                     26a. FICE CODE 003624

27. RESIDENCY STATUS                              28. ACADEMIC CLASS                          29. PROJECTED GRADUATION DATE                                         30. ACADEMIC MAJOR

31. ACADEMIC MINOR                                                                      32. CREDITS TOWARD DEGREE                               33. CREDITS REQUIRED FOR DEGREE                                  34. CGPA (COLLEGE)

35. OTHER COLLEGES ATTENDED                                                                                                    35a. YEAR(S) ATTENDED                        36. HIGH SCHOOL ATTENDED

36a. GRADUATION DATE                                                             37. ROTC SCHOLARSHIP RECIPIENT                                                     37a. If "yes" what type?

38. OTHER SCHOLARSHIPS                                                                                                                                                      39. JROTC EXPERIENCE

                                                     PART III - CURRENT OR PRIOR MILITARY SERVICE (TO INCLUDE OFFICER PRODUCING PROGRAMS)
             NOT APPLICABLE (Go to PART IV)                          40. CURRENT SERVICE:              Are you currently in the Armed Forces?                   40a. If "yes" which Branch?

40b. SMP UNIT                                                                                                                                                                          40c. Is your spouse currently a member of the Armed Forces?   N

41. PRIOR SERVICE:              Have you ever been enrolled in an officer producing program?                    41a. Were you ever disenrolled from the ROTC Program?

41b. Were you ever enrolled in a Service Academy?                N    41c. 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 Service                   41g. Have you ever been discharged for medical reasons?                  41 h. If "yes", explain:


CC Form 139-R, DEC 07                                           REPLACES ALL PREVIOUS EDITIONS, WHICH ARE OBSOLETE.                                                                                                                      Page 1 of 6
                                                                                                                                                                                                       Last Name
                                                                                                CADET ENROLLMENT RECORD
                                                                                                                                                                                                                                   SSN
                                                                                                        PART IV - STUDENT STATEMENTS
 42. RELEASE OF INFORMATION
 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. Army
 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. The
 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.
                I have read and understand the above statement concerning data required by the Privacy Act of 1974.
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 provide
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.
43. STATEMENT OF CRIMINAL PROCEEDINGS BY CIVIL OR MILITARY AUTHORITIES
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
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
$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,
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
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.
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.


                                          I have used illegal substances or drugs only on an experimental or limited basis.                When:                                                                      How Often:

                                       I have been a recent or frequent user of illegal substances or drugs.                               When:                                                                      How Often:
NOTE: Any future drug use will be grounds for disenrollment from the ROTC Program.
45. RELIGIOUS ACCOMMODATION
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 will
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.
            I have read and understand the above statement concerning accommodation of my religious practices.

46. CONSCIENTIOUS OBJECTION
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."
        Check One:                I am not a conscientious objector.                        I am a conscientious objector.         Explain:
47. DOD HOMOSEXUAL CONDUCT POLICY BRIEFING
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
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 any
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.
I understand I will be disenrolled from the SROTC Program if one or more of the following findings is made:
a. I have engaged in, have attempted to engage in, or have solicited another to engage in homosexual act or acts.
b. I have made a statement that demonstrates a propensity or intent to engage in homosexual acts.
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?
            I have read and understand the briefing concerning the DoD Homosexual Conduct Policy.



 "All information given on this form is correct to the best of my knowledge."                      SIGNATURE OF CADET

48. LOYALTY OATH (OPTIONAL FOR NONCONTRACTED CADETS)
" 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 CADET                                                                                                                                               DATE

CC Form 139-R, DEC 2007                                                                                                                                                                                                                           Page 2 of 6
                                                                                                                                                                                                        Last Name
                                                                                                CADET ENROLLMENT RECORD
                                                                                                                                                                                                                                     SSN
                                                                                 PART V - BASIC COURSE ENROLLMENT ELIGIBILITY CHECKLIST*
ALL NONCONTRACTED CADETS MUST MEET THE FOLLOWING CRITERIA TO ENROLL IN THE BASIC COURSE:
Enrollment Eligibility Officer: Verify the criteria below and sign the certification on page 5.
49. ACADEMIC STATUS                               Eligible: 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 undergraduate
                                                             or graduate degree at a host or partnership school.
                                                  Ineligible (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.

                                                  Ineligible: 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 have
                                                                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. CHARACTER                                     Eligible: Good moral character. No domestic violence conviction.

                                                  Ineligible: Nonwaiverable. Domestic violence misdemeanor or felony conviction.


52. TATTOOS                                       Eligible: Student does not have any tattoos specifically prohibited by Army policy (see ineligible below).

                                                  Ineligible: (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                                   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)).

                                                  Approval Required: (a) Immigrant Alien (b) Refugee (NOTE: Aliens are ineligible for scholarship and SMP, even if approved for enrollment).

                                                  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
                                                             condition/physical impairment that precludes enrollment in the basic course.
                                                  Ineligible (Waiver denied or nonwaiverable): Qualified medical physician refuses to complete and sign DA Form 3425-R for the student.

* NOTE: ENROLLMENT ELIGIBILITY OFFICER WILL CHECK THE INFORMATION IN PARTS I - III AND THE STUDENT'S STATEMENTS IN PART IV AND ADVISE THE STUDENT IF A
WAIVER IS REQUIRED PRIOR TO CONTRACTING I.E., AGE, RE-CODE, DEPENDENCY, CIVIL CONVICTION, SUBSTANCE ABUSE, ETC. (Waiver approval is not guaranteed).
                                                                             PART VI - NONSCHOLARSHIP CONTRACTING ELIGIBILITY CHECKLIST
ALL NONSCHOLARSHIP CADETS MUST MEET THE FOLLOWING CRITERIA TO CONTRACT:
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 CRITERIA                             Eligible: Student meets criteria 49-54 on the Basic Course Enrollment Eligibility Checklist (Part V).

                                                  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 fine
                                                             of less than $250. (b) Not guilty verdict or successful appeal of a conviction.

                                                  Waiver Required (Prior to Contracting): Any civil conviction, adverse adjudication, or court-martial conviction other than minor traffic violations (Exception: Alcohol-related driving offenses)
                                                           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
                                                             expunged, sealed, set aside, dismissed, or original finding or pleas changed still require a waiver.

                                                                                                                                                    Waiver Granted (Eligible):           Date
                                                  Ineligible (Waiver denied or nonwaiverable): (a) Pending charges for violating any civil law; (b) On supervised and/or conditional probation.

57. DEPENDENCY                                    Eligible: (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
                                                             court order in the custody of an adult relative/legal guardian and the student is not required to pay child support.

                                                  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
                                                          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
                                                            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.
                                                                                                                                                    Waiver Granted (Eligible):           Date
                                                  Ineligible (Waiver denied or nonwaiverable): Single parents who have legal custody of their children who are under 18 years old.

CC Form 139-R, DEC 2007                                                                                                                                                                                                                            Page 3 of 6
                                                                                                                                                                                                        Last Name
                                                                                                 CADET ENROLLMENT RECORD
                                                                                                                                                                                                                             SSN
                                                                    PART VI - NONSCHOLARSIP CONTRACTING ELIGIBILITY CHECKLIST (CONTINUED)
ALL NON-SCHOLARSHIP CADETS MUST MEET THE FOLLOWING CRITERIA TO CONTRACT:
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,
                                                              unless disqualified by DoDMERB.
                                                  Waiver 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
                                                             frequent and/or habitual use of chemical substances or drugs prior to contracting.

                                                                                                                                                    Waiver Granted (Eligible):            Date
                                                  Ineligible (Waiver denied or nonwaiverable) Chemical substance or drug abuse requiring professional care, which is medically disqualifying.

59. LOYALTY OATH                                  Eligible: Cadet signed loyalty oath.

                                                  Ineligible: Refuses to sign loyalty oath.

60. PRIOR SERVICE                                 Eligible: (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).
                                                  Waiver Required: (a) Honorably discharged with an RE code other than 1 on DD Form 214.                            Waiver Granted (Eligible):          Date

                                                  Ineligible (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 to
                                                             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
                                                            officer. (e) On Active Duty at time of contracting. A soldier on terminal leave is ineligible until actual separation.
                                                            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 (a
                                                            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).

61. CITIZENSHIP                                   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)).

                                                  Ineligible (Nonwaiverable): Non-U.S. citizen.

62. PLACEMENT CREDIT                              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 combination
                                                             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
                                                            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 =
                                                             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.
                                                             Two years = PMS may award up to MS I credit. Three years = PMS may award up to full Basic Course credit.
                                                  Ineligible (Waiver denied/Nonimmigrant Aliens)

63. ACADEMIC STATUS                               Eligible: (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.
                                                  Waiver Required: Graduate student with less than full time enrollment (waiverable).                        Waiver Granted (Eligible):          Date

                                                  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 FITNESS                              Eligible: Score 180, with a minimum of 60 points in each event, on a single APFT.

                                                  Ineligible (Nonwaiverable): Failure to meet eligibility criteria.

65. MEDICAL                                       Eligible: Student is fully medically qualified by a DoDMERB physical.

                                                  Waiver Required: Student is medically disqualified by a DoDMERB or MEPS physical, if applicable.                         Waiver Granted (Eligible):          Date

                                                  Ineligible (Waiver denied or nonwaiverable).

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.

                                                  Waiver 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.
                                                             NOTE: Retirement benefits are at risk for 33 and higher.                          Waiver Granted (Eligible):  Date
                                                  Ineligible (Waiver denied or nonwaiverable): Student is younger than 17 at time of contracting.
CC Form 139-R, DEC 2007                                                                                                                                                                                                                       Page 4 of 6
                                                                                                                                                                                                Last Name
                                                                                               CADET ENROLLMENT RECORD
                                                                                                                                                                                                                             SSN
                                                                                            PART VII - SCHOLARSHIP ELIGIBILITY CHECKLIST
ALL SCHOLARSHIP CADETS MUST MEET THE FOLLOWING CRITERIA TO CONTRACT:
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
criteria in order to apply. Refer to the current Green to Gold application for details.
67. PREVIOUS CRITERIA                           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 meet
                                                            criteria 55-62 on the Advanced Course Eligibility Checklist (Part VI). (NOTE: Alternate Entry Option students are ineligible for scholarship).
                                                Ineligible: 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.                                Waiver Granted (Eligible):         Date
                                                Ineligible (Waiver denied or nonwaiverable).
69. MAJOR                                       Eligible: Student is majoring in one of the majors listed in CC Reg 145-1.
                                                Waiver Required: Student is not majoring in one of the majors listed in CC Reg 145-1.                        Waiver Granted (Eligible):         Date
                                                Ineligible (Waiver denied).

70. AGE                                         Eligible: 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.
                                                Ineligible (Statutory-Nonwaiverable): Student exceeds the statutory maximum age requirement IAW CC Reg 145-1.

71. ACADEMIC STATUS                             Eligible: 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 GPA                             OR                    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 cumulative
                                                           high school GPA of less than 2.5 on a 4.0 scale. (c) Graduate student who is enrolled less than full time.
                                                                                                                                             Waiver Granted (Eligible):     Date
                                                Ineligible (Waiver denied or nonwaiverable).

72. ACT/SAT                                     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 or
                                                           greater OR composite SAT score of 920 or greater.
                                                                                                   SCORE: SAT Verbal                          SAT Math                                 ACT Composite

                                                Waiver 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.
                                                                                               SCORE: SAT Verbal                             SAT Math                               ACT Composite

                                                                                                                                              Waiver Granted (Eligible):         Date
                                                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                            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 at
                                                          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 have
                                                          7 semesters/10-11 quarters remaining.
                                                Waiver Required: If the student does not meet the criteria above.                             Waiver Granted (Eligible):         Date

                                                Ineligible (Waiver denied).

74. PHYSICAL FITNESS                            Eligible: 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
                                                          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.

                                                Ineligible (Nonwaiverable): Failure to meet eligibility criteria.

                                                                                           PART VIII - ENROLLMENT OFFICER CERTIFICATION
Certify by signature as many as applicable:
              BASIC COURSE: Student is eligible (fully or by waiver) for entry into the Basic Course.
                    Name/Rank:                                                                              Signature:                                                                                               Date:

            NONSCHOLARSHIP: Student is eligible (fully or by waiver) to contract as a nonscholarship.
                    Name/Rank:                                                                              Signature:                                                                                               Date:

            SCHOLARSHIP: Student is eligible (fully or by waiver) to contract as a scholarship recipient.

                    Name/Rank:                                                                              Signature:                                                                                               Date:
CC Form 139-R, DEC 2007                                                                                                                                                                                                                   Page 5 of 6
                                                                                                     CADET ENROLLMENT RECORD
                                                                                                 Instructions and Notes (CC Pam 145-4)
The purpose of the Cadet Enrollment Record (CC Form 139-R) is threefold:
 1. To record necessary information for entering a Cadet into the CCIMS database.
 2. To create a legal record of Cadet enrollment.
 3. To guide the Enrollment Eligibility Officer through the process of determining eligibility for enrollment and contracting.

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
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.
Contracting any student is subject to the approval of the PMS, even when all other eligibility criteria are met.
Cadre will verify that the information on this form is current and accurate during each required periodic counseling with the Cadet.

Reproduction of this form on cardstock for durability is recommended. You may fill in permanent information in ink and changeable items in pencil.
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.
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.

Notes and references:
Part I-III Height 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.
                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.
Part V     Basic Course Enrollment Eligibility (Noncontracted Cadets): See notes/instructions for Part V.
           (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.
           (4) Tattoos: AR 670-1, dtd 1 Jul 02, para 1-8e, TRADOC MSG dtd 011525Z, Subj: TRADOC/USAREC IET RECRUIT/CADET TATTOO/BRAND POLICY
           (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
                (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
                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 aliens
                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.
           (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 found
                in AR 40-501 and CC Pam 145-4.
Part VI    Nonscholarship Contracting Eligibility: See notes/instructions for Part VI.
           (1) Basic Course Eligibility Requirements: Cadet must meet basic course eligibility requirements - (1) - (6).
           (2) Civil Conviction: AR 145-1, Ch3; CC Reg 145-1; CC Pam 145-4; and AR 601-210, Ch 4.
           (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 parent
               applicants to turn over legal custody; they may only advise on eligibility standards IAW Army policy.
           (4) Substance Abuse: AR 145-1, Ch 3; CC Pam 145-4.
           (5) Loyalty Oath: Statutory: DoD Dir 1215.8; AR 145-1, Ch 3; CC Pam 145-4. Aliens specifically exempted by law.
           (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.
           (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-560
                (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
                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 aliens
                for enrollment refer to AR 145-1, Ch 3, and CC Pam 145-4).
           (8) Placement Credit: AR 145-1, Ch 3; CC Reg 145-1.
           (9) Academic Alignment: CC Pam 145-4.
           (10) Physical Fitness: AR 145-1, Ch 3; CC Reg 145-1; Cc Pam 145-4; Cadet scholarship and non-scholarship contracts.
           (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 in
                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.
           (12) Age: Statutory: AR 145-1, Ch 3; CC Reg 145-1; CC Pam 145-4.
Part VII   Scholarship Contracting Eligibility. See notes/instructions for Parts VI and VII.
           (1) Basic Contracting Eligibility Requirements: Cadet must meet basic contracting eligibility requirements in Part VI.
           (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 in
                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.
           (3) Major: CC Reg 145-1, Appendix F.
           (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.
           (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 2007                                                                                                                                                                                                                   Page 6 of 6
      BRIEFING ON GOVERNMENT SPONSORED BENEFITS FOR ROTC CADETS
                                    (ROTC Cadet Cmd PAM 145-4)


I have been briefed this date on government-sponsored benefits for ROTC cadets and
understand that--

1. Enrolled ROTC cadets and applicants for enrollment who suffer illness/injury as a
result of authorized (scheduled and supervised) training, or authorized travel to and from
such training, are eligible for compensation through the Department of labor/Department
of Veteran Affairs.

2. ROTC cadets may not receive medical coverage and disability benefits from the
Department of Labor or the Department of Veteran Affairs for injuries sustained when
traveling off-post for personal recreation/activities. It is the responsibility of the
individual cadet to obtain adequate or additional insurance to cover themselves for off-
post, non-ROTC related activities.

3. ROTC cadets must report any injury/illness sustained while participating in authorized
training or authorized travel to and from such training to the battalion commander/PMS
or other authorized cadre. Cadets are responsible for submission of claims to the proper
department as listed in paragraph 1 above, with the assistance of battalion cadre.

4. Army medical treatment facilities (subject to the availability of space, facilities, and
capabilities of the professional staff) are authorized to provide care for injury incurred or
disease contracted while attending field training.

5. Injured students who are eligible to receive medical treatment are authorized medical
care from the following sources:

            a. U.S. Public Health Service hospitals or physicians where available.

            b. Army, Navy, Air Force, or VA medical treatment facilities, subject to the
availability of space, facilities, and the capabilities of the professional staff.




DATE                                              CADET SIGNATURE


                                                  Printed Name of Cadet
CC FM 136-R, Aug 01
                    AUTHORIZATION/DECLINATION FOR ACCESS TO STUDENT RECORDS
                             For use of this form, see CC Pam 145-4, the proponent agency is ATCC-PC


                                  DATA REQUIRED BY THE PRIVACY ACT OF 1974

Authority                20 USC 1232g, and Public Law 93-380
Principal Purpose        To authorize/decline the release of any and all official records maintained by the ROTC
                         Department to personnel in the Department of Defense and/or parents.
Routine Uses             To provide authorization/declination to release information contained in official records.
Disclosure               Disclosure is voluntary.


                        PART I - AUTHORIZATION FOR ACCESS TO STUDENT RECORDS


Having been advised of the provisions of Public Law 93-380 (20 USC 1232g, Family Educational Rights and
Privacy Act of 1974) and in connection with my participation in the Army ROTC program, I

                                     ,,                                              hereby authorize the release of any and
                               (Cadet's Name)


all official records maintained by the
                                                                                         (Name of School)


or it's ROTC Department to personnel in the Department of Defense and/or my parents,

                                                                                                                      .
                                                    (Name of Parents)


I waive any requirement that I be furnished a copy of those records prior to or concurrent with their
release. This consent remains effective until my relationship with the ROTC program is terminated.




Signature of Cadet                                                                                 Date


                    PART II - DECLINATION OF PARENTAL ACCESS TO STUDENT RECORDS


Although informing my parents of the academic/ROTC progress made by me may assist in my quest to
become a commissioned officer, I decline to allow release of official records maintained by

                         Stephen F. Austin State University                                         ROTC Department to my
                                     (Name of School)


parents. (Exception: Parents who still claim student as a dependent for IRS purposes) If I change my mind in the
future, I will inform the ROTC Department in writing.




Signature of Cadet                                                                                 Date

CC FORM 137-R, AUG 02                                 PREVIOUS EDITIONS ARE OBSOLETE
                        MEDICAL FITNESS STATEMENT                                 DATE
           FOR ENROLLMENT IN BASIC COURSE, SENIOR ROTC
            For use of this form, see AR 145-1, the proponent agency is ODSCPER




               I have examined                                    ,,              and find no medical
condition or physical impairment that precludes his/her participation in the basic course, Army ROTC, a
program not more physically strenuous than a normal college physical education program.




SIGNATURE OF PHYSICIAN


                                                                                                          USAPPC V1.00
DA FORM 3425-R, 1 SEP 68
                                             Contracting Forms


                                      DEPARTMENT OF DEFENSE FORMS
DD FORM 4/1         ENLISTMENT/REENLISTMENT DOCUMENT ARMED FORCES OF THE UNITED STATES
DD FORM 93          RECORD OF EMERGENCY DATA
DD FORM 785         RECORD OF DISENROLLMENT FROM OFFICER CANDIDATE-TYPE TRAINING
DD FORM 2005        PRIVACY ACT STATEMENT-HEALTH CARE RECORDS
DD 2058             STATE OF LEGAL RESIDENCE CERTIFICATE
DD FORM 2480        DODMERB REPORT OF DENTAL EXAMINATION (GREEN TO GOLD ONLY)
DD FORM 2492        DODMERB REPORT OF MEDICAL HISTORY

                                     DEPARTMENT OF THE ARMY FORMS
DA FORM 597         ARMY SENIOR RESERVE OFFICERS TRAINING COURSE (ROTC) NON SCHOLARSHIP CONTRACT
DA FORM 597-1       ACKNOWLEDGEMENT OF UNDERSTANDING-NON SCHOLARSHIP TWO YEAR PROGRAM
DA FORM 597-3       ARMY SENIOR RESERVE OFFICERS TRAINING COURSE (ROTC) SCHOLARSHIP CONTRACT
DA FORM 705         APFT SCORECARD
DA FORM 4824-R      ADDEMDUM TO CERTIFICATE AND ACKNOWLEDGEMENT OF SERVICE REQUIREMENTS
                    FOR ALL PERSONNEL APPLYING FOR PARTICIPATION IN ROTC SMP

                                         CADET COMMAND FORMS
CC FORM 132-R       STATEMENT OF UNDERSTANDING (DEPENDENCY)
CC FORM 202-R       GRFD NON-SCHOLARSHIP CADET CONTRACT ENDORSEMENT
CC FORM 203-R       GRFD SCHOLARSHIP CADET CONTRACT ENDORSEMENT
CC FORM 204-R       REVOCATION OF GRFD SCHOLARSHIP CADET CONTRACT ENDORSEMENT
CC FORM 226-R       REQUEST FOR CONVERSION TO GUARANTEED RESERVE FORCES DUTY (GRFD)
                    OR DEDICATED ARMY NATIONAL GUARD (ARNG) SCHOLARSHIP
CC FORM 227-R       REQUEST FOR RESERVE FORCES DUTY (GRFD) CONTROL NUMBER

                                                NGB FORMS
NGB FORM 594-1      ANNEX TO DD FORM 4/DA FORM 4836-SMP AGREEMENT ARNG
NGB FORM 5435-1-R   SUPPLEMENTAL TO DD FORM 4 - STATEMENT OF UNDERSTANDING THE ARNG MONTGOMERY
                    GI BILL KICKER PROGRAM

                                                MISC FORMS
SGLV 8296           SERVICEMAN'S GROUP LIFE INSURANCE ELECTION AND CERTIFICATE
SF 1199             DIRECT DEPOSIT SIGN UP FORM
                                                                                    RECORD OF EMERGENCY DATA

                                                                     PRIVACY ACT STATEMENT
AUTHORITY: 5 USC 552, 10 USC 655, 1475 to 1480 and 2771, 38 USC 1970, 44 USC 3101, and EO 9397 (SSN).
PRINCIPAL PURPOSES: This form is used by military personnel and Department of Defense civilian and contractor personnel, collectively referred to as civilians, when applicable. For
military personnel, it is used to designate beneficiaries for certain benefits in the event of the Service member's death. It is also a guide for disposition of that member's pay and
allowances if captured, missing or interned. It also shows names and addresses of the person(s) the Service member desires to be notified in case of emergency or death. For civilian
personnel, it is used to expedite the notification process in the event of an emergency and/or the death of the member. The purpose of soliciting the SSN is to provide positive
identification. All items may not be applicable.
ROUTINE USES: None.
DISCLOSURE: Voluntary; however, failure to provide accurate personal identifier information and other solicited information will delay notification and the
processing of benefits to designated beneficiaries if applicable.


                     INSTRUCTIONS TO SERVICE MEMBER                                                                  INSTRUCTIONS TO CIVILIANS
This extremely important form is to be used by you to show the names and addresses of            This extremely important form is to be used by you to show the names and addresses of your spouse,
your spouse, children, parents, and any other person(s) you would like notified if you           children, parents, and any other person(s) you would like notified if you become a casualty.
become a casualty (other family members or fiance), and, to designate beneficiaries for          Not every item on this form is applicable to you. This form is used by the Department of Defense (DoD)
certain benefits if you die. IT IS YOUR RESPONSIBILITY to keep your Record of                    to expedite notification in the case of emergencies or death. It does not have a legal impact on other
Emergency Data up to date to show your desires as to beneficiaries to receive certain            forms you may have completed with the DoD or your employer.
death payments, and to
show changes in your family or other personnel listed, for example, as a result of
marriage, civil court action, death, or address change.


                                   IMPORTANT: This form is divided into two sections: Section 1 - Emergency Contact Information and Section 2 - Benefits Related
                                               Information. READ THE INSTRUCTIONS ON PAGES 3 AND 4 BEFORE COMPLETING THIS FORM.

                                                                             SECTION 1 - EMERGENCY CONTACT INFORMATION

1. NAME (Last, First, Middle Initial)                                                                      2. SSN




3a. SERVICE/CIVILIAN CATEGORY                                                                                                                             b. REPORTING UNIT CODE/DUTY STATION
ARMY c           NAVY c         MARINE CORPS c    AIR FORCE c          DoD   c      CIVILIAN c    CONTRACTOR c


4a. SPOUSE NAME (If applicable) (Last, First, Middle Initial)                         b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER



SINGLE       c      DIVORCED        c    WIDOWED c



5. CHILDREN                                       a. NAME b. RELATIONSHIP             c. DATE OF BIRTH     d. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER
(Last, First, Middle Initial)                                                         (YYYYMMDD)




6a. FATHER NAME (Last, First, Middle Initial)                   b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER




7a. MOTHER NAME (Last, First, Middle Initial)                   b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER




8a. DO NOT NOTIFY DUE TO ILL HEALTH                             b. NOTIFY INSTEAD




9a. DESIGNATED PERSON(S) (Military only)                                              b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER




10. CONTRACTING AGENCY AND TELEPHONE NUMBER (Contractors only)




DD FORM 93, JAN 2008                                            PREVIOUS              TION IS OBSOL ETE
                                                                EDITI
                                                  SECTION 2 - BENEFITS RELATED INFORMATION

11a. BENEFICIARY(IES) FOR DEATH GRATUITY            b. RELATIONSHIP     c. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER          d. PERCENTAGE
(Military only)




12a. BENEFICIARY(IES) FOR UNPAID PAY/ALLOWANCES                         b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER          c. PERCENTAGE
(Military only) NAME AND RELATIONSHIP




13a. PERSON AUTHORIZED TO DIRECT DISPOSITION (PADD)                     b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER
(Military only) NAME AND RELATIONSHIP




14. CONTINUATION/REMARKS




15. SIGNATURE OF SERVICE MEMBER/CIVILIAN (Include rank, rate, or      16. SIGNATURE OF WITNESS (Include rank, rate, or grade as   17. DATE SIGNED
grade if applicable)                                                  appropriate)                                                (YYYYMMDD)




DD FORM 93 (BACK), JAN 2008
                                      RECORD OF DISENROLLMENT FROM                                                                      DATE SUBMITTED
                                     OFFICER CANDIDATE - TYPE TRAINING
TO: (Appropriate agency of the service concerned) (Include Zip Code)                     FROM: (Appropriate agency of the service concerned) (Include Zip Code)




                                  SECTION I - IDENTIFICATION INFORMATION ON STUDENT AT TIME DISENROLLED
1. LAST NAME - FIRST NAME - MIDDLE INITAL                       2. RATE OR GRADE         3. BRANCH OF ARMED          4. FILE OR SERVICE              5. SOCIAL SECURITY
                                                                                         FORCES                      NUMBER                          NUMBER
                             ,,
6                a. DATE                b. PLACE                                                                                                     7. SEX
        BIRTH              --                                                              ,
8. HOME OF RECORD ADDRESS                                                                9. OTHER


,

                                     SECTION II - PROGRAM INFORMATION APPLICABLE AT TIME DISENROLLED
10. TRAINING STATION ADDRESS                                                   11. TYPE OF PROGRAM (OCS,             12. SPECIFIC TYPE OF TRAINING (Supply, Pilot
                                                                                 ROTC, Academy, NavCad, etc.)           training, Bombardier, Infantry, Artillery, etc.)


                                                                                               ROTC
13. DATE ENTERED PROGRAM                                        14. DATE DISENROLLED                                 15. DATE SCHEDULED FOR COMMISSION (If
                                                                                                                     training had been completed successfully)


                                         SECTION III - REASONS AND CIRCUMSTANCES FOR DISENROLLMENT




                                          SECTION IV - EVALUATION TO BE CONSIDERED IN THE FUTURE FOR
                                            DETERMINING ACCEPTABILITY FOR OTHER OFFICER TRAINING
    1       HIGHLY RECOMMENDED
              2    RECOMMENDED AS AN AVERAGE CANDIDATE
                     3   SHOULD NOT BE CONSIDERED WITHOUT WEIGHING THE "NEEDS OF THE SERVICE" AGAINST THE REASONS
                         FOR THIS DISENROLLMENT
                           4    RECOMMENDED IF PHYSICAL DEFECTS ARE CORRECTED OR IF SUCH DEFECTS ARE NOT
                                DISQUALIFYING FOR OTHER PROGRAMS
                                   5    DEFINITELY NOT RECOMMENDED
    6       OTHER REMARKS

REMARKS




TYPED NAME AND GRADE                                                                     SIGNATURE



DD Form 785, JUN 68 (EG)                                    REPLACES EDITION OF 1 MAR 64 WHICH IS OBSOLETE AFTER 31 DEC 68.                        Designed using Perform Pro, WHS/DIOR, Jan 97
                          PRIVACY ACT STATEMENT - HEALTH CARE RECORDS
         THIS FORM IS NOT A CONSENT FORM TO RELEASE OR USE HEALTH CARE INFORMATION PERTAINING TO YOU.
 1. AUTHORITY FOR COLLECTION OF INFORMATION INCLUDING SOCIAL SECURITY NUMBER (SSN)


   Sections 133, 1071-87, 3012, 5031 and 8012, title 10, United States Code and Executive Order 9397.




 2. PRINCIPAL PURPOSES FOR WHICH INFORMATION IS INTENDED TO BE USED



   This form provides you the advice required by The Privacy Act of 1974. The personal information will
   facilitate and document your health care. The Social Security Number (SSN) of member or sponsor is
   required to identify and retrieve health care records.




 3. ROUTINE USES




   The primary use of this information is to provide, plan and coordinate health care. As prior to enactment
   of the Privacy Act, other possible uses are to: Aid in preventive health and communicable disease control
   programs and report medical conditions required by law to federal, state and local agencies; compile
   statistical data; conduct research; teach; determine suitability of persons for service or assignments; adjudicate
   claims and determine benefits; other lawful purposes, including law enforcement and litigation; conduct
   authorized investigations; evaluate care rendered; determine professional certification and hospital
   accreditation; provide physical qualifications of patients to agencies of federal, state, or local government
   upon request in the pursuit of their official duties.




 4. WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVIDING INFORMATION




   In the case of military personnel, the requested information is mandatory because of the need to document
   all active duty medical incidents in view of future rights and benefits. In the case of all other personnel/
   beneficiaries, the requested information is voluntary. If the requested information is not furnished, comprehensive
   health care may not be possible, but CARE WILL NOT BE DENIED.



   This all inclusive Privacy Act Statement will apply to all requests for personal information made by health
   care treatment personnel or for medical/dental treatment purposes and will become a permanent part of
   your health care record.




   Your signature merely acknowledges that you have been advised of the foregoing. If requested, a copy of
   this form will be furnished to you.




 SIGNATURE OF PATIENT OR SPONSOR              SSN OF MEMBER OR SPONSOR                             DATE




DD FORM 2005, FEB 76                              PREVIOUS EDITION IS OBSOLETE.
                                              STATE OF LEGAL RESIDENCE CERTIFICATE
                                              DATA REQUIRED BY THE PRIVACY ACT OF 1974
       AUTHORITY:                     Tax Reform Act of 1976, Public Law 94-455.

       PURPOSE:                       Information is required for determining the correct State of legal residence for purposes of withholding
                                      State income taxes from military pay.

       ROUTINE USES:                  Information herein will be furnished State authorities and to Members of Congress.

       MANDATORY OR                   Disclosure is voluntary. If not provided, State income taxes will be withheld based on the tax laws of the
       VOLUNTARY                      State previously certified as your legal residence, or in the absence of a prior certification, the tax laws of
       DISCLOSURE:                    the applicable State based on your home of record.
 NAME (Last, first, middle initial)                                                                               SOCIAL SECURITY NUMBER (SSN)
,,
 LEGAL RESIDENCE/DOMICILE (City or county and State)


                                  INSTRUCTIONS FOR CERTIFICATION OF STATE OF LEGAL RESIDENCE

       The purpose of this certificate is to obtain information with respect to your legal residence/domicile for the purpose of determining
       the State for which income taxes are to be withheld from your "wages" as defined by Section 3401(a) of the Internal Revenue Code
       of 1954. PLEASE READ INSTRUCTIONS CAREFULLY BEFORE SIGNING.

       The terms "legal residence" and "domicile" are essentially interchangeable. In brief, they are used to denote that place where you
       have your permanent home and to which, whenever you are absent, you have the intention of returning. The Soldiers’ and Sailors’
       Civil Relief Act protects your military pay from the income taxes of the State in which you reside by reason of military orders unless
       that is also your legal residence/domicile. The Act further provides that no change in your State of legal residence/domicile will
       occur solely as a result of your being ordered to a new duty station.

       You should not confuse the State which is your "home of record" with your State of legal residence/domicile. Your "home of
       record" is used for fixing travel and transportation allowances. A "home of record" must be changed if it was erroneously or
       fraudulently recorded initially.

       Enlisted members may change their "home of record" at the time they sign a new enlistment contract. Officers may not change their
       "home of record" except to correct an error, or after a break in service. The State which is your "home of record" may be your State
       of legal residence/domicile only if it meets certain criteria.

       The formula for changing your State of legal residence/domicile is simply stated as follows: physical presence in the new State with
       the simultaneous intent of making it your permanent home and abandonment of the old State of legal residence/domicile.
       In most cases, you must actually reside in the new State at the time you form the intent to make it your permanent home. Such intent
       must be clearly indicated. Your intent to make the new State your permanent home may be indicated by certain actions such as: (1)
       registering to vote; (2) purchasing residential property or an unimproved residential lot; (3) titling and registering your
       automobile(s); (4) notifying the State of your previous legal residence/domicile of the change in your State of legal
       residence/domicile; and (5) preparing a new last will and testament which indicates your new State of legal residence/domicile.
       Finally, you must comply with the applicable tax laws of the State which is your new legal residence/domicile.

       Generally, unless these steps have been taken, it is doubtful that your State of legal residence/domicile has changed. Failure to
       resolve any doubts as to your State of legal residence/domicile may adversely impact on certain legal privileges which depend on
       legal residence/domicile including among others, eligibility for resident tuition rates at State universities, eligibility to vote or be a
       candidate for public office, and eligibility for various welfare benefits. If you have any doubt with regard to your State of legal
       residence/domicile, you are advised to see your Legal Assistance Officer (JAG Representative) for advice prior to completing this
       form.

       I certify that to the best of my knowledge and belief, I have met all the requirements for legal residence/domicile in the State claimed
       above and that the information provided is correct.

       I understand that the tax authorities of my former State of legal residence/domicile will be notified of this certificate.

 SIGNATURE                                                           CURRENT MAILING ADDRESS (Include ZIP Code)                         DATE
                                                                     ,,
DD Form 2058, FEB 77 (EG)                                                                                 Designed using Perform Pro, WHS/DIOR, Jul 94
                                   DOD MEDICAL EXAMINATION REVIEW BOARD (DODMERB)                                                                                        Form Approved
                                             REPORT OF MEDICAL HISTORY                                                                                                   OMB No. 0704-0396
           (This information is for official and medically confidential use only and will not be released to unauthorized persons.)                                      Expires Aug 31, 2003
The public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection
of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports
(0704-0396), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be
subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number.
PLEASE DO NOT RETURN YOUR FORM TO THE ABOVE ADDRESS. RETURN COMPLETED FORM TO DODMERB/DR, 8034 EDGERTON
DRIVE, SUITE 132, USAF ACADEMY CO 80840-2200.

                                                                                 PRIVACY ACT STATEMENT
AUTHORITY: Title 10, USC 133, 3012, 5031, 8013, and Executive Order 9397.

PRINCIPAL PURPOSE: To determine medical acceptability or update a medical file as part of the application process to a United States Service Academy,
Reserve Officer Training Corps (ROTC) Scholarship Program, or the Uniformed Services University of the Health Sciences (USUHS).
ROUTINE USES: This information may be disclosed to the Coast Guard Academy and Merchant Marine Academy for applications to their Academies.

DISCLOSURE: Voluntary; however, failure to furnish the requested information will impede the selection process and hamper your candidacy. Use of the
Social Security Number (SSN) is used for positive identification of records.
1. NAME (Last, First, Middle Initial)                                                         2. SOCIAL SECURITY NUMBER                       3. TELEPHONE NO. (Include area code)
,,
4. PURPOSE OF EXAMINATION                         5. EXAMINATION FACILITY OR EXAMINER AND ADDRESS (Include ZIP Code)                                                  6. DATE OF EXAMINATION
                                                                                                                                                                        (YYYYMMDD)
Contracting Physical for US Army
ROTC

SECTION I
  Mark each item "Yes" or "No". Every question must be answered. Every "Yes" must be explained in the REMARKS section. Mark and
explain each item to the best of your ability. Be perfectly honest! Your medical records may be requested to clarify your medical history.
7. HAVE YOU EVER OR DO                      YES NO                                 YES NO DO YOU                                         9a. If you wear contact lenses, how many days have they
YOU NOW USE ANY OF                                       Marijuana                            8. Wear glasses                            been removed prior to this examination?
YES NO THE FOLLOWING:                                    Alcohol (Amount                      9. Wear contact lenses or                  Less than 3                     3-20              21 or over
             Amphetamines                                frequency, treatment                 corneal eye retainers
                                                                                                                                              Type lens:                 Hard                 Soft
             Barbiturates                                if any)                              (If Yes, complete 9a.)
             Cocaine                                     Chemical Inhalants                   10. HAVE YOU EVER HAD YOUR VISION IMPROVED BY METHODS OTHER THAN STATED
             Narcotic Drugs                              Hallucinogens                        IN QUESTIONS 8 OR 9?
YES NO HAVE YOU EVER HAD OR DO YOU NOW HAVE:                             YES NO                                                          YES NO
       11. Eye trouble (exclude glasses, contact lenses)                           40. Gallbladder trouble or gallstones                           66. Sleepwalking episodes after age 12
             12. Have fluctuating vision or double vision                          41. Hepatitis (yellow jaundice)                                 67. Easily fatigued
             13. Have any allergies                                                42. Hemorrhoids or rectal disease                               68. Motion sickness (car, train, sea, or air)
             14. Take any medications regularly                                    43. Black or bloody stools                                      69. X-ray or other radiation therapy
             15. Stutter or stammer                                                44. Frequent or painful urination                               70. Sensitivity to chemicals, dust, sunlight, etc.
             16. Frequent, severe, or migraine headaches                           45. Bed wetting after age 12                                    71. Learning disabilities or speech problems
             17. Fainting or dizzy spells                                          46. Blood, protein, or sugar in urine                 YES NO HAVE YOU EVER
             18. Periods of unconsciousness                                        47. History of diabetes                                         72. Been refused employment or been unable to
             19. Head injury or skull fracture                                     48. Kidney stone                                                hold a job or stay in school because of:
             20. Epilepsy, seizures or convulsions                                 49. Hernia or rupture                                             a. Inability to perform certain movements?
             21. Loss of memory (amnesia)                                          50. Any bone or joint problem, injuries, surgery or                b. Inability to assume certain positions?
             22. Depression, anxiety, excessive worry, or                          medical treatment                                                  c. Other medical reasons?
               nervousness                                                                                                                         73. Been rejected for or discharged from military
                                                                                   51. Steel pins, plates, or staples in any bones
                                                                                                                                                   service because of physical, mental or
             23. Any mental condition or illness                                   52. Wear a bone or joint brace or support                       other reasons?
             24. Frequent trouble sleeping                                         53. Back pain or trouble                                        74. Been denied or rated up for life insurance?
             25. Hearing loss                                                      54. Paralysis or weakness                                       75. Received or applied for pension or
             26. Ear, nose, or throat trouble                                      55. Foot trouble/use orthotics                                     compensation for existing disability?
             27. Sinusitis or sinus trouble                                        56. Rheumatic fever                                             76. Had or been advised to have, any surgical
             28. Hay fever or allergic rhinitis                                    57. Tuberculosis or positive TB test                               operations?
             29. Tooth/gum trouble, or current orthodonitcs                        58. Sexually transmitted disease (syphilis,                     77. Consulted, or been treated by clinics,
                                                                                     gonorrhea, herpes)                                              hospitals, physicians, healers, or other
             30. Thyroid trouble
                                                                                                                                                     practitioners for other than minor illnesses?
             31. Chronic cough or lung disease                                     59. Skin conditions such as acne, psoriasis,                    78. Had any injury or illness other than those
             32. Asthma or wheezing                                                  hand or foot rashes, eczema, or dry skin                        already noted?
             33. Unusual shortness of breath                                       60. Adverse reaction to vaccines, drugs,              YES NO FEMALES ONLY (Complete Items 79 - 82)
             34. Pain or pressure in chest                                           medicines, foods, insect bites or stings                   79. Been treated for a female disorder, painful
             35. Palpitation or pounding heart                                     61. Eating disorder                                               periods, or cramps
             36. Heart trouble or heart murmur                                     62. Recent gain or loss of weight                               80. Had a change in menstrual pattern
             37. High blood pressure                                               63. Excessive bleeding or easy bruising                         81. Are you now pregnant?
             38. Coughed up or vomited blood                                       64. Tumor, growth, cyst, or cancer                              82. Date of last menstrual period (YYYYMMDD)
             39. Stomach, liver, or intestinal trouble                             65. Considered or attempted suicide
DD FORM 2492, MAR 2004                                                          PREVIOUS EDITION IS OBSOLETE.                                   DoD Exception to SF93 approved by GSA/IRMS (8-91)
SECTION II
83. REMARKS. Every "yes" response in items 7 through 81 must be explained in the space provided. Give specific dates and details
  including names of physicians and hospitals or clinics and the current status of the condition. Continue on a separate sheet and attach
  to this form if additional space is needed.




84. CERTIFICATION. I certify that I have reviewed the foregoing information supplied by me and that it is true and complete to the best of my
knowledge. I authorize any of the physicians, hospitals, or clinics mentioned above to furnish the Government a complete transcript of my
medical record for purposes of processing my application for this employment or service.
TYPED OR PRINTED NAME OF EXAMINEE SIGNATURE                                        SIGNATURE                                                    DATE SIGNED
                                                                                                                                                (YYYYMMDD)



NOTE: HAND TO THE PHYSICIAN OR NURSE, OR IF MAILED MARK ENVELOPE "TO BE OPENED BY MEDICAL PERSONNEL ONLY."
85. EXAMINER'S SUMMARY AND ELABORATION OF ALL PERTINENT DATA (Examiner shall comment on all "Yes" and blank answers (indicating the item number
before each comment). Develop by interview any additional medical history deemed important, and record significant findings here. If additional space is needed,
continue on a separate sheet and attach to this form.)




86. PHYSICIAN OR EXAMINER                                                                                                                       87. NUMBER OF
TYPED OR PRINTED NAME DATE SIGNED                             SIGNATURE                                                 DATE SIGNED              ATTACHED
                                                                                                                              (YYYYMMDD)         SHEETS


DD FORM 2492 (BACK), MAR 2004
         ARMY SENIOR RESERVE OFFICERS’ TRAINING CORPS (ROTC) NONSCHOLARSHIP CADET CONTRACT
                                         For use of this form see AR 145-1; the proponent agency is DSC G-1
                                              DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY:                Title 10, USC, Sections 2101 through 2111, and 3013. Title 5, USC, Section 301.

PRINCIPAL PURPOSE:        To specify the contractual agreements and obligations and to document contracting in the Army Senior Reserve Officers'
                          Training Corps Nonscholarship Program.

ROUTINE USES:             This form will be maintained in the cadet's Miliary Personnel Records Jacket and becomes a permanent part of the official
                          personnel records as confirmation of enrollment, contracting, obligation and agreements.

DISCLOSURE:               Disclosure of the information requested in this contract is voluntary. However, applicable portions must be completed if the
                          applicant desires to be contracted in the Army ROTC Nonscholarship Program.

                                                                    PREAMBLE

TThis contract represents an agreement entered into between the United States Army and the Reserve Officers' Training Corps (ROTC)
nonscholarship cadet named herein, with the consent of the parent or guardian if the cadet is under the age of 18, to effect said cadet's
participation in the Army Reserve Officers' Training Corps Program. It is hereby agreed by both parties, the United States Army and the
Cadet, that the sole purpose of the ROTC nonscholarship program is to produce officers for the United States Army. Entry into this program
is a serious commitment. This commitment must be made with the resolve to attain a commission. If there are any doubts about the
prospective cadet's ability or determination to fulfill the terms of this contract, then this contract should not be executed. In consideration of
the mutual benefits, which will accrue to the parties hereto by reason of the cadet's participation in the Army ROTC and later service in the
United States Army, the parties agree to the terms below.

                                                                    CONTRACT
A. STUDENT'S NAME (Last, First, MI)                                     D. NAME OF EDUCATIONAL INSTITUTION
,,
B. SSN                                                                  E. ADDRESS OF EDUCATIONAL INSTITUTION
                                                                        P.O. Box 13059, SFA Station
C. DATE OF BIRTH (YYYYMMDD)                                             NacogdochesTX, 75962

F. DATE EDUCATION                     G. COMPLETION DATE                H. ADDRESS OF RECORD (Include ZIP Code)
COMMENCES (YYYYMMDD)                  (YYYYMMDD)

                                                                        ,,
I. ACADEMIC MAJOR IN WHICH DEGREE IS TO BE ATTAINED


                           PART I - AGREEMENT OF THE DEPARTMENT OF THE ARMY
1. DEPARTMENT OF THE ARMY AGREEMENT. In consideration of the agreement in Part II below, the Department of the
Army agrees to--

    a. PAY MONTHLY SUBSISTENCE. Pay a subsistence allowance for participation in the nonscholarship program for 10
months of any academic year (or the actual duration of the academic year, whichever is shorter) at the rate of $                   350
for MS II cadets; $         450 for MS III cadets; $          500 for MS IV cadets; and $                  for MS V cadets, for no
more than a total of 30 months. These rates are generally prescribed by law and implemented by the Secretary of Defense and
may change during the period of this contract.

    b. PAY FOR ATTENDANCE AT LEADER DEVELOPMENT AND ASSESSMENT COURSE (LDAC) . Provide a daily rate
of pay, which is prescribed by law for cadets of the United States Military Academy and implemented by the Department of
Defense Military Pay and Allowance Entitlements Manual (DODPM), for the period that the cadet attends LDAC.

     c. PROVIDE TRAINING. Provide the cadet with U.S. Army-sponsored and -funded Reserve Officer Training.

   d. DELAY ACTIVE DUTY FOR GRADUATE/PROFESSIONAL STUDY. The obligated period of active duty this contract
requires may be delayed upon commissioning, if the cadet's application for resident graduate or professional study is
approved, until the completion of the authorized delay.

     e. COMMISSION AS AN OFFICER. Upon satisfactory completion of the academic, military, and all other requirements
of the Army ROTC program, a cadet may be appointed as a reserve officer in the Army in the grade of second lieutenant.

DA FORM 597, JUL 2005                            DA FORM 597, AUG 2004, IS OBSOLETE.                                                          Page 1 of 5
                                                                                                                                                 APD 9V1.000
             PART II - AGREEMENT OF NONSCHOLARSHIP CADET CONTRACTING IN THE SENIOR ROTC PROGRAM
2. GENERAL CADET AGREEMENT. As the ROTC nonscholarship cadet named above, I agree to do the following:

       a. ENLISTMENT AGREEMENT. As a condition for membership in the Army ROTC Program, I agree to enlist in the
Reserve Component of the United States Army (with assignment to the USAR Control Group (ROTC)) for a period prescribed by the
Secretary of the Army.

        b. ENROLLMENT AGREEMENT. I agree to enroll in the necessary courses and successfully complete, within the
prescribed time, the requirements for the degree in the academic major stated above. I agree to remain enrolled in and successfully
complete the ROTC program, including LDAC and all training as prescribed by the Secretary of the Army or
his/her designee, as a prerequisite for commissioning.

         c. FULL-TIME STUDENT AGREEMENT. I agree to remain a full-time student in good standing at the educational
institution named above until I receive my degree. A full-time student is defined as one enrolled in sufficient academic courses to obtain
junior and senior academic status at the end of each appropriate one-academic-year increment for the duration of my
college program. This includes the required Army ROTC classes, which may be part of or in addition to those courses required
for my degree. If I desire to transfer to another institution or take a leave of absence from the continuous performance of this
contract, I agree to obtain prior written approval from the Professor of Military Science (PMS).

       d. ACADEMIC GRADE POINT AVERAGE AGREEMENT. I agree to maintain, at a minimum, a cumulative academic
grade point average of 2.0 on a 4.0 or equivalent scale. This grade point average must also be maintained for each
semester or quarter. If I am required by my academic major or by the school I am attending to maintain a higher cumulative
and semester or quarter grade point average, I agree to maintain that higher standard until the completion of the academic
requirements for my degree. I understand and agree that failure to maintain the minimum academic grade point average may
subject me to disenrollment from the ROTC program.

         e. ROTC COURSES GRADE POINT AVERAGE AGREEMENT. I agree to maintain at least a 2.0 on a 4.0 or equivalent
scale, cumulative and semester or quarter academic grade point average in all ROTC courses. I understand and agree that
failure to maintain the minimum ROTC courses grade point average may subject me to disenrollment from the ROTC program.

       f. MEDICAL AND PHYSICAL FITNESS STANDARDS.

                (1) I agree to maintain eligibility for enrollment and retention in ROTC and commissioning, as defined by statute,
Army regulation, and this contract, throughout the period of this contract. I agree to meet and maintain the Army Physical Fitness Test
(APFT) standard and the screening weight or body fat percentage required by the Army Weight Control Program as required of active duty
soldiers each year and prior to attendance at ROTC LDAC. These will be continuous requirements that I must continue to meet until the
date that I report to Officer Basic Course (OBC) or a Reserve Component unit and thereafter. Commissioning eligibility standards, including
the APFT and Army Weight Control Program standards, are subject to change, and I must keep myself informed of such changes through
contact with the PMS. I understand and agree that failure to maintain the weight and physical fitness requirements may subject me to
disenrollment from the ROTC program.



               (2) I agree to undergo precommissioning drug and alcohol screening tests, normally administered during
LDAC training, or as may otherwise be prescribed by U.S. Army Cadet Command. If the result of any test is positive, I will be subject to
disenrollment from the ROTC program.

                 (3) I agree to undergo testing for HIV (Human Immunodeficiency Virus) antibody during my precommissioning
physical examination, normally during LDAC training or as the U.S. Army Cadet Command may otherwise prescribe. If the result of the
testing is confirmed positive, I will be disenrolled from the ROTC program.

         g. NURSE CADET AND MEDICAL SPECIALIST CORPS CADET ADDITIONAL AGREEMENT. I agree, if I am a nurse
candidate or a medical specialist corps cadet, to complete a baccalaureate program from an accredited and approved
educational institution with an academic and clinical curriculum in English; I also agree to complete my ROTC training
requirements by my projected commissioning date and accept, if offered, a commission in the USAR. I further understand that
if selected for active duty Army Nurse Corps or Army Medical and Specialist Corps, I must first pass the professional degree
and licensing exam requirements set forth in relevant Army regulations prior to entry on active duty for my particular specialty.
If a nurse cadet, I will take the exam not later than 60 days after graduation. If I fail the exam, I must retake it within 120
days after the first exam. If I fail my nurse licensing examination for the second time, I will be branched based on the needs of
the Army.



DA FORM 597, JUL 2005                                                                                                               Page 2 of 5
                                                                                                                                       APD 9V1.000
      PART II - AGREEMENT OF NONSCHOLARSHIP CADET CONTRACTING IN THE SENIOR ROTC PROGRAM (Continued)
3. ADDITIONAL TERMS AND CONDITIONS. I further understand that--

          a. DISCLOSURE OF DISQUALIFYING CONDITIONS. By executing this contract, I represent that I meet all
eligibility criteria for contracting in the ROTC Program and commissioning, as defined by statute, Army regulation, and
this contract. I represent that I have disclosed or will disclose any and all re-existing medical conditions and
non-medical conditions that would bake me ineligible for enrollment in the ROTC program as specified in statute, Army
regulations (including but not limited to AR 145-1) and this contract. If I am ineligible for contracting in ROTC based
on a particular medical or non-medical condition, but such ineligibility my be waived, I must obtain an approved waiver
before executing this contract. Failure to have disclosed or to disclose any disqualifying condition, including any
conditions I should have known about, will subject me to disenrollment from the ROTC program. I certify that I have
been notified of the Department of Defense Homosexual Conduct Policy, and I understand that my sexual orientation
does not make me ineligible for contracting with the Army. Therefore, nothing in this paragraph requires a disclosure of
my sexual orientation in violation of the Department of Defense Homosexual Conduct Policy as addressed in AR 600-20.

        b. NATURE OF DUTIES AND CONSCIENTIOUS OBJECTOR STATUS. My acceptance of the terms and
conditions of this agreement signifies my readiness to bear arms, to engage in and support combat operations and to
operate and support operations of approved weapon systems. If I at any time apply for and receive conscientious
objector status, I will be disenrolled from the program. If conscientious objector status is approved, my failure to
complete the service obligation within this contract will result in my disenrollment.

       c. CADET OBLIGATION.

                  (1) CADETS. I understand and agree that I will incur an active duty obligation after the first day of my MS
III year (junior year) .

                (2) GREEN-TO-GOLD CADETS. If I was conditionally discharged from the active Army to become a
nonscholarship advanced course cadet, I am obligated and may not voluntarily withdraw from the ROTC program from
the date of discharge without incurring an active duty obligation as stipulated in paragraph 5 of this contract. The only
exception to this requirement is if I am disenrolled from ROTC because of personal hardship. In case of personal
hardship, I may request to be returned to active duty in my enlisted status to serve out the time remaining on my original
active duty enlistment contract instead of the active duty obligation stipulated in paragraph 5b of this contract if there is
at least on year remaining on my original active duty enlistment and I am otherwise eligible for active duty.

4. CADET AGREEMENTS UPON PROGRAM COMPLETION. Upon completion of all requirements for appointment, to
include medical qualification, all prescribed military science courses, LDAC, and any other training that my be prescribed
by the Secretary of the Army or his or her designee, I agree to, as prescribed by the Secretary of the Army, complete the
following requirements:

        a. ACCEPTANCE OF APPOINTMENT. I agree to accept an appointment, if offered, as a commissioned officer in
the USAR or ARNGUS, in accordance with governing Army regulations. I understand that upon appointment, I will incur a total
military service obligation not to exceed eight (8) years and cannot resign such appointment before completion; however,
this obligation may be met in a variety of ways as outlined below. I further understand that active duty service may
include worldwide assignment or assignment to a branch that involves combat or exposure to nuclear, chemical, or
biological weapons.

              (1) ACTIVE DUTY ASSIGNMENT. If selected for such duty, I agree to serve on active duty as a
commissioned officer in the U.S. Army or for the time prescribed by relevant Army regulations based on the needs of the
Army, followed by service in the USAR Control Group (Reinforcement) or a Troop Program Unit (TPU) until the
remainder of my eight-year contractual military service obligation has been served.

                 (2) RESERVE COMPONENT ASSIGNMENT. If I am not selected for extended active duty, I will
serve a short period of active duty or active duty training if appointed in a Reserve Component. I will complete an
duty, I will complete an officer's basic course for branch qualification. This will be followed by service in a
officer's basic course for branch qualification. This will be followed by service in a Reserve Component Unit (ARNGUS)
or USAR) , which has Monthly Unit Training Assemblies and an annual training period of approximately two weeks, until
the remainder of my contractual military service obligation has been served.


DA FORM 597, JUL 2005                                                                                                           Page 3 of 5
                                                                                                                                   APD 9V1.000
      PART II - AGREEMENT OF NONSCHOLARSHIP CADET CONTRACTING IN THE SENIOR ROTC PROGRAM (Continued)
                (3) UNAVAILABILITY OF TROOP PROGRAM ASSIGNMENT. If I am fulfilling my obligation
through Reserve Component duty and an appropriate troop program unit assignment is not available as defined by
applicable Army regulations or becomes unavailable in either the U.S. Army Reserve or the Army National Guard of the
United States, I agree to participate as a member of the Individual Mobilization Augmentee (IMA) program by serving at
least twelve (12) days, excluding travel time, on annual training each fiscal year as directed by the Human Resources
Command-St Louis (HRC-St Louis) . If neither an appropriate unit nor an IMA assignment is available, I agree to
participate as a member of the Individual Ready Reserve (IRR) by serving up to twelve (12) days of training each fiscal
year until such time as an appropriate unit or IMA assignment becomes available or until the expiration of my
contractual military service obligation. I may be required to travel the distance specified in Army regulations to fulfill my
contractual military service obligation.

                  (4) THE ARMY NATIONAL GUARD COMBAT REFORM INITIATIVE (ANGCRI) . If I am offered the
opportunity to participate in the Army National Guard Combat Reform Initiative (ANGCRI) , I understand and agree that
in return for participation in the ANGCRI program, I will serve my remaining service obligation in an Army National Guard
unit, in lieu of completing my active duty service obligation, including mandatory service requirements as prescribed by
Federal statute, Army regulation, and my ROTC contract. Furthermore, if I voluntarily, or because of misconduct, fail to
complete my obligated Reserve service in an Army National Guard unit, the Army may require me to return to active
duty to complete the remainder of my service obligation.

        b. APPLICATION FOR RESERVE COMPONENT DUTY ASSIGNMENT. I understand that I may apply for a
Reserve Component appointment and request service on active duty or service with a Reserve Component Unit
(ARNGUS or USAR) at my discretion. However, my selection for the appointment and service shall be determined
according to the needs of the Army at the time that my requested appointment is considered. Further, specific career
field choices and branch assignments cannot be guaranteed but will be made according to the needs of the Army.

5. TERMS OF DISENROLLMENT. I understand and agree that if I am disenrolled from the ROTC program for breach
 of contractual terms or any other disenrollment criteria established now or in the future by Army regulations (which
include, but are not limited to, AR 145-1) incorporated herein by reference, I am subject to the terms in paragraphs 5a,
5b and 5c below-

       a. I AGREE TO SERVE ON ENLISTED ACTIVE DUTY. Under the terms of this contract, the Secretary of the
Army or his or her designee, may order me to active duty as an enlisted soldier, if I am qualified, for a period of not
more than two (2) years if I fail to complete the ROTC program and am disenrolled after the point of obligation. Any
unexpired portion of my enlistment obligation remaining after such active duty must be served in the USAR Control
Group (Reinforcement).

       b. I AGREE TO TRANSFER TO THE INDIVIDUAL READY RESERVE (IRR), IF APPLICABLE. If I am disenrolled
from ROTC and assigned to the ROTC Control Group, and I am not ordered to active duty and am not pending such an
order under the terms of this contract, applicable Army regulations, or statute, then-

                (1) If I have3 previously completed basic training (BT) or eight weeks of one station unit training (OSUT)
and I do not join a troop program unit then I will be transferred to the Individual Ready Reserve.

               (2) If I have not completed BT or eight weeks of OSUT and I have no previous military service, I will be
discharged from the USAR unless I find a Reserve unit vacancy and am accepted t fill that vacancy within 60 days of
disenrollment.

       c. I AGREE THAT PENDING DISCHARGE, I MAY NOT ENLIST. I may not enlist in the active Army, another military,
service, or in a military academy while I am a contracted ROTC cadet unless I am properly discharged from the ROTC program.

6. LEAVE OF ABSENCE. If I am placed in a leave of absence due to my failure to meet academic or military retention
standards as prescribed by statue, Army regulations, or this contract, I will not be relieved of my obligations to the
U.S. Army and my obligations under this contract remain in effect.

7. RELEASE FROM OBLIGATIONS. I understand that the Secretary of the Army or his/her designee may at any time
release me without notice from the obligations under this contract and disenroll me from the ROTC Program without
further benefits hereunder if, in the opinion of the Secretary of the Army or his or her designee, it is in the best interest
of the Army.




DA FORM 597, JUL 2005                                                                                                           Page 4 of 5
                                                                                                                                   APD 9V1.000
      PART II - AGREEMENT OF NONSCHOLARSHIP CADET CONTRACTING IN THE SENIOR ROTC PROGRAM (Continued)


8. COMPLIANCE WITH AND CHANGES IN ELIGIBILITY REQUIREMENTS. I acknowledge that I have discussed the
eligibility requirements pertaining to enrollment in ROTC, enlistment in the USAR or ARNG, and accepting a
commission as an officer, with the PMS or other designated and authorized ROTC cadre members, and that I understand
these requirements. I realize that these requirements may change in the future. I agree to keep myself apprised of all
changes in requirements and to maintain my eligibility to participate in ROTC at all times in the future. I also agree to
inform the PMS of an change in my eligibility (medical and non-medical) based on current or revised requirements as
soon as I know or should have known, recognizing my agreement to keep myself apprised of all applicable
changes in requirements. Failure to so advise the PMS of such a change in eligibility that I was aware of or should have
been aware of may result in disenrollment.


9. ORDER TO ACTIVE DUTY IN THE EVENT OF A WAR. I understand that either as an enlisted member or as a
commissioned officer in the Reserve Component of the Army of the United States or upon my transfer or assignment
thereto, I may be ordered to active duty without my consent in the event of a war, a national emergency declared by
Congress or the President, an order of the Selected Reserve to active duty authorized by the President, and as otherwise
authorized by low, such call to active duty could be for the duration of a war or any period of time authorized by law.


10. COMPLETE AGREEMENT AND SEVERABILITY. I understand the provisions in the contract contain the only binding
promises by and to both parties. This agreement controls over any conflicting advice or information that I may have
received orally or in writing from Cadet Command, my PMS, other cadre, cadets or others regarding my obligations and
agreements to the Army. If any provision within this agreement is determined to be invalid or unenforceable by a court of
law, the remaining terms and agreements remain in full force and effect.

J. HOME ADDRESS (Include Zip Code)                                    K. SIGNATURE


,,                                                                    L. DATE (YYYMMDD)


       PART III – CONSENT OF PARENT OR GUARDIAN TO CONTRACT IN ROTC AND ENLIST IN THE U.S. ARMY RESERVE
                   (To be completed if applicant is under 18 years of age at time of contracting in the ROTC program)
11. I certify that I am the applicant's parent or legal guardian, and that the applicant's date of birth as shown above is
correct.

12. I consent to applicant's enrollment in the ROTC and to enlistment in the USAR.

13. I have read and thoroughly understand the above statements of terms under which the applicant is being enrolled
I relinquish all claims to applicant's service and to any wages or compensation for such service. I understand that the
applicant will be subject to all of the requirements and lawful commands of the officers who may from time to time be
placed over the applicant, and I certify that no promise or any kind has been made to me concerning the applicant's
assignment to duty or appointment as an officer as an inducement to me to sign this contract.

M. SIGNATURE OF PARENT OR GUARDIAN                    N. SIGNATURE OF WITNESS                               S. DATE (YYYMMDD)



                        PART IV - CONFIRMATION OF ENROLLMENT AS AN ROTC NONSCHOLARSHIP CADET
                                      (And of Enrollment in the ROTC Program, If not previously enrolled)

14. On the basis of the above executed contract (Part II) , and the executed consent of the                    P. EFFECTIVE DATE OF
parent or guardian (Part III) , if applicable, I have selected and enrolled this applicant as a cadet          ENROLLMENT (YYYYMMDD)
in the ROTC Program on the effective date of enrollment in item P.
                                              PART V - FOR THE SECRETARY OF THE ARMY
Q. NAME OF ROTC CONTRACTING OFFICIAL (Print or Type)                                                           S. DATE (YYYYMMDD)


R. SIGNATURE OF ROTC OFFICIAL


DA FORM 597, JUL 2005                                                                                                               Page 5 of 5
                                                                                                                                       APD 9V1.000
                ACKNOWLEDGEMENT OF UNDERSTANDING – NONSCHOLARSHIP TWO YEAR PROGRAM
                                    For use of this form see AR 145-1; the proponent agency is MILPERCEN

                                          DATA REQUIRED BY THE PRIVACY ACT OF 1974

AUTHORITY:                   Title 10, USC, Section 3012.


PRINCIPAL PURPOSE:           To explain obligation and participation requirements specifically directed for
                             Individuals without any prior military training entering the nonscholarship two
                             year program

ROUTINE USES:                Record is to be maintained in the Military Personnel Records Jacket as confirmation
                             of enrollment, obligation and participation requirements.

DISCLOSURE:                  Disclosure of the information requested in DA Form 597-1 is voluntary. However,
                             applicable portions must be completed if the applicant is to be enrolled in the ROTC
                             nonscholarship two year program.

STUDENT’S NAME (Last, First, MI)                                                                           SOCIAL SECURITY NUMBER

,,                                                                                                                         0

NAME AND ADDRESS OF SCHOOL                                                                                 DATE OF BIRTH

P.O. Box 13059, SFA Station                                                                                                //
Nacogdoches,TX 75962
                                                     EXPLANATION TO STUDENT



After the Professor of Military Science has reviewed with you the contents of DA Form 597 (Army SROTC Nonscholarship
Contract) and you have signed Part I of said contract, you should read the contents of this document carefully and request
clarification if required. You must then sign this form in order for your contract to become effective. Following completion of this
form, to include your parent or guardian’s signature on this document if you are a minor, you will be given a copy of this form for
your own records


                                            ACKNOWLEDGEMENT OF UNDERSTANDING




In consideration of being allowed to enter the Advanced Course of the nonscholarship two year program without having any prior
qualifying military training and in addition to my obligations in Part I of DA Form 597, I hereby agree to the following conditions:


 a. That I will diligently pursue the attainment of my degree and that I will pursue to completion all portions of the ROTC
 commissioning program




DA FORM 597-1, JUN 85                                                                                                           USAPPC V1.00
b. That I will attend the ROTC Basic Camp during the summer immediately following my entry into Military Science III. Further, I
agree to attend the Advanced Camp following completion of the MS IV course. Failure on my part to fulfill conditions is a breach
of nonscholarship contract.




HOME ADDRESS (Include ZIP Code)
0
,,

SIGNATURE OF STUDENT                                                                          DATE




                         ACKNOWLEDGEMENT OF UNDERSTANDING OF PARENT OR GUARDIAN
                                                (To be completed if applicant is a minor)




I have read and thoroughly understand the above statements of terms that the applicant is being enrolled as a nonscholarship
cadet in the two year ROTC program.




SIGNATURE OF PARENT OR GUARDIAN                                                               DATE




SIGNATURE OF WITNESS                                                                          DATE




DA FORM 597-1, JUN 85                                                                                               USAPPC V1.00
         ARMY SENIOR RESERVE OFFICERS’ TRAINING CORPS (ROTC) SCHOLARSHIP CADET CONTRACT
                                      For use of this form see AR 145-1; the proponent agency is DCS G-1
                                          DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY:                 Title 10, USC, Sections 2005, 2101 through 2111, and 3013. Title 5, USC Section 301.

PRINCIPAL PURPOSE: To specify the contractual agreements and obligations and to document your enrollment in the Army Senior Reserve
                           Officers’ Training Corps Scholarship Program.

ROUTINE USES:              This form will be maintained in your Military Personnel Records Jacket and becomes a permanent part of your official
                           personnel records as confirmation of enrollment, obligation and agreements.

DISCLOSURE:                Disclosure of the information requested in this contract is voluntary. However, applicable portions must be completed if
                           you desire to be enrolled in the Army ROTC Nonscholarship Program.

                                                                 PREAMBLE

This contract represents an agreement entered into between the United States Army and the Reserve Officers'Training
Corps (ROTC) scholarship recipient (cadet) named herein, with the consent of the parent or guardian ifthe cadet is
under the age of 18, to effect cadet's participation in the Army Reserve Officers' Training CorpsProgram. It is hereby
agreed by both parties, the United States Army and the Cadet, that the sole purpose of the ROTC scholarship program
is to produce officers for the United States Army. Entry into this program is a seriouscommitment. This commitment
must be made with the resolve to attain a commission. If there are any doubtsabout the prospective cadet's ability or
determination to fulfill the terms of this contract, then this contract should not be executed. In consideration of the
mutual benefits which will accrue to the parties hereto by reason of the cadet's participation in the Army ROTC and later
service in the United States Army, the parties agree to the terms below

                                                                 CONTRACT
A. STUDENT’S NAME (Last, First, MI)                                      D. NAME OF EDUCATIONAL INSTITUTION
,,
B. SSN                                                                   E. ADDRESS OF EDUCATIONAL INSTITUTION
                                                                     0 P.O. Box 13059, SFA Station
C. DATE OF BIRTH                                                       Nacogdoches, TX, 75962

F. DATE EDUCATION                     D. COMPLETION DATE                 H. ADDRESS OF RECORD (Include ZIP Code)
COMMENCES (YYYYMMDD)                  (YYYYMMDD)                                                                                                        0
                                                                         ,,
I. ACADEMIC MAJOR IN WHICH DEGREE IS TO BE ATTAINED
                                                                     0
J    EXTENDED BENEFITS                K PERIOD COVERED                   L DATE APPROVED                         M. AUTHORIZED
RECEIVED                                                                 (YYYYMMDD)


                                   PART I – AGREEMENT OF THE DEPARTMENT OF THE ARMY
1. DEPARTMENT OF THE ARMY AGREEMENTS. In consideration of the agreement in Part II below, the
Department of the Army agrees to--

       a. PAY SCHOLARSHIP BENEFITS. Pay for a period of                                      academic years (provided funds are
appropriated by Congress) the following:

                   (1) TUITION AND FEES. Tuition and educational fees up to an annual amount of $                               Full Tuition/Fees   .

                 (2) BOOKS AND LABORATORY EXPENSES. A flat rate of $                     1200 , which may increase
during the period of this contract, will be reimbursed as established on an annual basis by the U.S. Army Cadet
Command, for textbooks, and laboratory expenses. This will be payable on the first day of enrollment for all
returning or previously enrolled cadets. The flat rate for new award winners will be paid promptly upon completion
of the 45-day requirement or upon validation of the scholarship contract whichever is later. (Any items the cadet
believes are needed that would exceed this rate must be purchased with other than Army funds.)


DA FORM 597-3, JUL 2005                        DA FORM 597-3, AUG 2004, IS OBSOLETE.                                                      Page 1 of 8
                                                                                                                                              APD 9V1.001
                          PART I – AGREEMENT OF THE DEPARTMENT OF THE ARMY (Continued)
                 (3) PAYMENT TERMS.

                           (a) Scholarship payment for tuitions and fees will be made if the cadet remains actively
enrolled as a scholarship student on the 45th day after the start of each academic year. The 45-day waiting
period applies only to the first term of each academic year (usually the Fall semester/quarter) . The waiting
period will not apply to the second semester or to second/third quarters. If the cadet enters into t scholarship
contract after the 45th day of the first term of the academic year, he or she is immediately eligible for
scholarship benefits payments.

                         (b) After the 45-day waiting period, payment for tuition and fees will be made to the
beginning of the term, or the date the cadet began the term, whichever is later, provided that this contract is
consummated before the end of that term.

                         (c) If the educational institution will not defer the payment of tuition and other fees until
the 45th day after the start of classes, the cadet is responsible for payment of the tuition and fees. The Army is
not obligated to pay any late fees incurred as a result of the cadet's failure to pay the cost of tuition and fees
prior to the 45th day.

         b. PAY MONTHLY SUBSISTENCE. Pay a subsistence allowance for participation in the scholarship
program for 10 months of any academic year (or the actual duration of the academic year, whichever is shorter)
at the rate of $ 300           per month for MS I cadets; $ 350           per month for MS II cadets; $ 450          per
month for MS III cadets; $ 500             per month for MS IV cadets; and $                  for MS V cadets. These
rates are generally prescribed by law and implemented by the Secretary of Defense and may change during the
period of this contract. Entitlement is not to exceed--

                 (1) 50 months for a 5-year scholarship (or extended benefits under 4-year scholarship).

                 (2) 40 months for a 4-year scholarship.

                 (3) 30 months for a 3-year scholarship.

                 (4) 20 months for a 2-year scholarship.

         c. PAY FOR ATTENDANCE AT LEADERSHIP AND ASSESSMENT COURS (LDAC) . Provide a daily
rate of pay, which is prescribed by law for cadets of the United States Military Academy and implemented by
the Department of Defense Military Pay and Allowance Entitlements Manual (DODPM) , for the period that the
cadet attends LDAC.

NOTE: Payment for travel from the cadet's home of record to the school listed above is not authorized under
this scholarship contract. (EXCEPTION: The only exception is for four-year, Military Junior Colleges (MJC), and
Green-to-Gold scholarship recipients who are paid for one time travel from home of record to school to accept an
appointment as a scholarship cadet and to enlist in the USAR Control Group (ROTC)).

        d. PROVIDE TRAINING. Provide the cadet with U.S. Army-sponsored and -funded Reserve Officer
Training.

        e. DELAY ACTIVE DUTY FOR GRADUATE/PROFESSIONAL STUDY. The obligated period of active duty
this contract requires may be delayed upon commissioning, if the cadet's application for resident graduate or
professional study is approved, until completion of the authorized delay.

        f. COMMISSION AS AN OFFICER. Upon satisfactory completion of the academic, military, and all other
requirements of the Army ROTC program, a cadet may be appointed as a reserve officer in the Army in the grade
of second lieutenant.

DA FORM 597-3, JUL 2005                                                                                                  Page 2 of 8
                                                                                                                            APD 9V1.001
               PART II – AGREEMENT OF SCHOLARSHIP CADET CONTRACTING IN THE SENIOR PROGRAM
2. GENERAL CADET AGREEMENT. As the ROTC scholarship cadet named above, I hereby agree to do the
following:

          a. ENLISTMENT AGREEMENT. As a condition for membership in the Army ROTC Program, I agree to
enlist in the Reserve Component of the United States Army (with an assignment to the USAR Control Group
(ROTC)) for a period prescribed by the Secretary of the Army.

         b. ENROLLMENT AGREEMENT. I agree to enroll in the necessary courses and successfully complete,
within the prescribed time, the requirements for the degree in the academic major state above. I agree to
remain enrolled in and successfully complete the ROTC program, including LDAC and all training as prescribed
by the Secretary of the Army or his/her designee, as a prerequisite for commissioning.

         c. FULL-TIME STUDENT AGREEMENT. I agree to remain a full-time student in good standing at the
educational institution named above until I receive my degree. A full-time student is defined as one enrolled in
sufficient academic courses to obtain sophomore, junior, and senior academic status at the end of each
appropriate one-academic-year increment for the duration of the scholarship. This includes the required Army
ROTC classes, which may be part of or in addition to those courses required for my degree. If I desire to
transfer to another institution or take a leave of absence from the continuous performance of this contract, I
agree to obtain prior written approval from the Professor of Military Science (PMS) .

          d. ACADEMIC GRADE POINT AVERAGE AGREEMENT. I agree to maintain at a minimum, a
cumulative academic grade point average of 2.0 on a 4.0 or equivalent scale. This grade point average must
also be maintained for each semester or quarter. If I am required by my academic major or by the school I am
attending to maintain a higher cumulative and semester or quarter grade point average, I agree to maintain
that higher standard until the completion of the academic requirements for my degree. I understand and agree
that failure to maintain the minimum academic grade point average may subject me to disenrollment from the
ROTC program.

        e. ROTC COURSE GRADE POINT AVERAGE AGREEMENT. I agree to maintain at least a 2.0 on a
4.0 or equivalent scale, cumulative and semester or quarter academic grade point average in all ROTC
courses. I understand and agree that failure to maintain the minimum ROTC courses grade point average may
subject me to disenrollment from the ROTC program.

        f. MEDICAL AND PHYSICAL FITNESS STANDARDS.

                  (1) I agree to maintain eligibility for enrollment and retention in ROTC and for commissioning,
as defined by statute, Army regulation, and this contract, throughout the period of this contract. I agree to
meet and maintain the Army Physical Fitness Test (APFT) standard and the screening weight or body fat
percentage required by the Army Weight Control Program as required of active duty soldiers each year and
prior to attendance at ROTC LDAC. These will be continuous requirements that I must continue to meet until the
date that I report to Officer Basic Course (OBC) or a Reserve Component unit and thereafter. Commissioning
eligibility standards, including the APFT and Army Weight Control Program standards, are subject to change,
and I must keep myself informed of such changes through contact with the PMS. I understand and agree that
failure to maintain the weight and physical fitness requirements may subject me to disenrollment from the
ROTC program.

                 (2) I agree to undergo, precommissioning drug and alcohol screening tests, normally
administered during LDAC training, or as may otherwise be prescribed by U.S. Army Cadet Command. If the
results of any test is positive, I will be subject to disenrollment from the ROTC program.

               (3) I agree to undergo testing for HIV (Human Immunodeficiency Virus) antibody during my
precommissioning physical examination; normally during LDAC training or as the U.S. Army Cadet Command
may otherwise prescribe. If the result of the testing is confirmed positive, I will be disenrolled from the ROTC
program.

DA FORM 597-3, JUL 2005                                                                                            Page 3 of 8
                                                                                                                      APD 9V1.001
          PART II – AGREEMENT OF SCHOLARSHIP CADET CONTRACTING IN THE SENIOR PROGRAM (Continued)
         g. NURSE CADET AND ARMY MEDICAL SPECIALIST CORPS CADET ADDITIONAL AGREEMENT. I
agree, if I am a nurse cadet or a medical specialist corps cadet, to complete a baccalaureate program from
an accredited and approved educational institution with an academic and clinical curriculum in English. I also
agree to complete my ROTC training requirements by my projected commissioning date and accept, if offered, a
commission in the USAR. I further understand that if selected for active duty in the Army Nurse Corps or Army
Medical Specialist Corps, I must first pass the professional degree and licensing exam requirements set forth in
relevant Army regulations prior to entry on active duty for my particular specialty. I a nurse cadet, I will take
the exam not later than 60 days after graduation. If I fail the exam, I must retake it within 120 days after the
first exam. If I fail my nurse licensing examination for the second time, I will be branched based on the needs of
the Army.

3. ADDITIONAL TERMS AND CONDITIONS. I further understand that--

          a. DISCLOSURE OF DISQUALIFYING CONDITIONS. By executing this contract, I represent that I meet
all eligibility criteria for contracting in the ROTC Program and commissioning, as defined by statute, Army
regulation, and this contract. I represent that I have disclosed or will disclose any and all pre-existing medical
conditions and non-medical conditions that would bake me ineligible for enrollment in the ROTC program as
specified in statute, Army regulation (including but not limited to AR 145-1) and this contract. If I am
ineligible for contracting in ROTC based on a particular medical or non-medical condition, but such ineligibility
my be waived, I must obtain an approved waiver before executing this contract. Failure to have disclosed or
to disclose any disqualifying condition, including any conditions I should have known about, will subject me to
disenrollment from the ROTC program and possible recoupment of scholarship benefits. I certify that I have
been notified of the Department of Defense Homosexual Conduct Policy, and I understand that my sexual
orientation does not make me ineligible for contracting with the Army. Therefore, nothing in this paragraph
requires a disclosure of my sexual orientation in violation of the Department of Defense Homosexual Conduct
Policy as addressed in AR 600-20.

        b. NATURE OF DUTIES AND CONSCIENTIOUS OBJECTOR STATUS. My acceptance of the terms and
conditions of this agreement signifies my readiness to bear arms, to engage in and support combat operations
and to operate and support operations of approved weapon systems. If I at any time apply for and receive
conscientious objector status, I will be disenrolled from the program. If conscientious objector status is
approved, my failure to complete the service obligation within this contract will result in my disenrollment, at
which point I may be required to reimburse the United States Government for advanced educational assistance
expended on my behalf.

        c. CADET OBLIGATION.

                  (1) CADETS. I understand and agree that I will incur an active duty and/or reimbursement
obligation after the first day of my MS II year (sophomore year) if I am a three-, four- or five-year scholarship
recipient; after the first day of my MS III year (junior year) if I am a two-year scholarship recipient; or after the
first day of my MS IV year (senior year) if I am a one-year or less scholarship recipient.

                 (2) GREEN-TO-GOLD CADETS. If I was conditionally discharged from the active Army to
become a scholarship recipient, I am obligated and may not voluntarily withdraw from the ROTC program from
the date of discharge without incurring an active duty or reimbursement obligation.

                          (a) If I am an MS I/freshman and I am disenrolled from the ROTC Program for any
reason, I may be returned to active duty fro the time not served on my original active duty enlistment when I
was separated to accept the ROTC scholarship. If I have less than one year remaining on my original active
duty enlistment and am not returned to active duty, I may be required to repay scholarship funds expended on
my behalf.
                          (b) If I am in the ROTC program beyond the MS I/freshmen year and am disenrolled, I
may be returned to active duty or I may be involuntarily ordered to active duty as stipulated in paragraph 6 of
this contract. In case of personal hardship, I may request return to active duty in my enlisted status to serve

DA FORM 597-3, JUL 2005                                                                                                 Page 4 of 8
                                                                                                                           APD 9V1.001
         PART II – AGREEMENT OF SCHOLARSHIP CADET CONTRACTING IN THE SENIOR PROGRAM (Continued)
out the time remaining on my original active duty enlistment contract instead of the active duty obligation
stipulated in paragraph of this contract.
NOTE: If I am a cadet with prior service, I understand that I will be required to serve any unexpired portion of
my pervious statutory enlistment obligation. The unexpired portion of my pervious statutory enlistment
obligation runs concurrently with my contractual military service obligation under this contract.
4. CADET AGREEMENTS UPON PROGRAM COMPLETION. Upon completion of all requirements for
appointment, to include medical qualification, all prescribed military science courses, LDAC and any other
training that my be prescribed by the Secretary of the Army or his or her designee, I agree to, as prescribed
by the Secretary of the Army, complete the following requirements:

        a. ACCEPTANCE OF APPOINTMENT. I agree to accept an appointment, if offered, as a
commissioned officer in the USAR or ARNGUS, in accordance with governing Army regulations. I understand
that upon appointment, I will incur a total military service obligation not to exceed eight (8) years and cannot
resign such appointment before completion; however, this obligation may be met in a variety of ways as
outlined below. I further understand that active duty service may include worldwide assignment and
assignment that involves combat or exposure to nuclear, chemical, or biological weapons.

                  (1) ACTIVE DUTY ASSIGNMENT. Serve up to 4 years on active duty as a commissioned
officer in the U.S. Army or for a period as prescribed by relevant Army regulations based on the needs of the
Army, followed by service in the Reserve Component as set forth in relevant Army regulations, until the
remainder of my eight-year contractual military service obligation has been served.

                  (2) RESERVE COMPONENT ASSIGNMENT. Serve a short period of active duty or
active duty training if appointed for duty in a Reserve Component. If I am not selected for extended active
duty, I will complete an officer's basic course for branch qualification. This will be followed by service in a
Reserve Component Unit (ARNGUS or USAR) , which has Monthly Unit Training Assemblies and an annual
training period of approximately two weeks until the remainder of my contractual military service obligation
has been served.

                    (3) UNAVAILABILITY OF TROOP PROGRAM ASSIGNMENT. If I am fulfilling my
obligation through Reserve Component duty and an appropriate troop program unit assignment is not
available or becomes unavailable in either the U.S. Army Reserve or the Army National Guard of the United
States, I agree to participate as a member of the Individual Mobilization Augmentee (IMA) program by serving
at least twelve (12) days, excluding travel time, on annual training each fiscal year as directed by the Human
Resources Command-St Louis (HRC-St Louis) . If it is determined that neither an appropriate unit nor an IMA
assignment is available, I agree to participate as a member of the Individual Ready Reserve (IRR) by serving
up to twelve (12) days of training each fiscal year until such time as an appropriate unit or IMA assignment
becomes available or until the expiration of my contractual military service obligation. I may be required to
travel the distance specified in Army regulations to fulfill my contractual military service obligation.
                    (4) THE ARMY NATIONAL GUARD COMBAT REFORM INITIATIVE (ANGCRI) . If I am offered
the opportunity to participate in the Army National Guard Combat Reform Initiative (ANGCRI) , I understand
and agree that in return for participation in the ANGCRI program, I will serve my remaining service obligation
in an Army National Guard unit, in lieu of completing my active duty service obligations, including mandatory
service requirements as prescribed by Federal statute, Army regulation, and my ROTC contract. Furthermore,
if I voluntarily, or because of misconduct, fail to complete my obligated Reserve service in an Army National
Guard unit, the Army may require me to return to active duty to complete the remainder of my service
obligation or the Army may seek recoupment against me.

        b. APPLICATION FOR RESERVE COMPONENT DUTY ASSIGNMENT. I understand that I may apply
for a Reserve Component appointment and request service on active duty or service with a Reserve
Component Unit (ARNGUS or USAR) at my discretion. However, my selection for the appointment and
service shall be determined according to the needs of the Army at the time that my requested appointment is
considered. Further, specific career field choices and branch assignments cannot be guaranteed but will be
made according to the needs of the Army no earlier than 12 months before commissioning.
DA FORM 597-3, JUL 2005                                                                                            Page 5 of 8
                                                                                                                      APD 9V1.001
         PART II – AGREEMENT OF SCHOLARSHIP CADET CONTRACTING IN THE SENIOR PROGRAM (Continued)
        c. If granted scholarship benefits beyond four years I am obligated to serve an additional period of
active duty equivalent to any scholarship entitlements extended beyond four years, e.g., six months for each
additional semester of financial assistance granted (or four months for each additional quarter of financial
assistance granted).

5. TERMS OF DISENROLLMENT. I understand and agree that once I become obligated and I am disenrolled
from the ROTC program for breach of contractual terms or any other disenrollment criteria established now or
in the future by Army regulations (which include, but are not limited to, AR 145-1) incorporated herein by
reference, I am subject to the terms in paragraphs 5a through 5e below--

         a. I AGREE TO SERVE ON ENLISTED ACTIVE DUTY. Under the terms of this contract, the Secretary
of the Army or his or her designee, may order me to active duty as an enlisted soldier, if I am qualified, for a
period of not more than four (4) years if I fail to complete the ROTC program. If I am disenrolled after the point
of obligation, I may be ordered to active duty for one of the periods listed in paragraph 6 below based upon the
year during which my disenrollment was initiated;

         b. I AGREE TO REIMBURSE THE UNITED STATES GOVERNMENT. If I am offered the opportunity to
repay my advanced educational assistance in lieu of being ordered to active duty, I will be required to reimburse
the United States government through repayment of an amount of money, plus interest, equal to the entire
amount of financial assistance (to include tuition, educational fees, books, laboratory expenses, and supplies)
paid by the United States for my advanced education form the commencement of this contractual agreement to
the date of my disenrollment or refusal to accept a commission. This amount includes any financial assistance I
may have received prior to my obligation point. I agree that any money I am determined to owe to the United
States shall bear interest at the rate equal to the highest rate being paid by the United States on securities
having maturity dates of ninety days or less and shall accrue from the day that I am first notified of the amount
I owe to the United States a reimbursement under this contract. I understand that I may be deemed to have
failed to comply with the terms and conditions of this contract (breach of contract) regardless of whether I
knew that the failure violated the contract and regardless of whether the failure was the result of an act or
omission on my part made with a specific intent to avoid responsibilities under the contract.

         c. FAILURE TO COMPLETE REQUIRED SERVICE OBLIGATION. I understand and agree that if I
voluntarily or because of misconduct fail to begin or fail to complete any period of active duty or duty in a
reserve status not on active duty that I have incurred under this contract whether as an officer or and enlisted
soldier, I will be required to reimburse the United States an amount of money, plus interest, that is equal to or
bears the same ratio to the total cost of the financial assistance provided to me by the United States as the
unserved portion of such duty bears to the total period of such duty I was obligated to serve.

        d. I AGREE THAT PENDING DISCHARGE FROM ROTC, I MAY NOT ENLIST. I may not enlist in the
active Army, another military service, or in a military service academy while I am a contracted ROTC cadet
unless I am properly released from my ROTC cadet status.

         e. I AGREE THAT ANY OBLIGATION TO REIMBURSE WILL NOT BE ALTERED BY SUBSEQUENT
ENLISTED DUTY. If I am disenrolled from ROTC, I understand the Secretary of the Army, or his or her
designee, retains the prerogative to either order me to active duty or order monetary repayment of my
scholarship benefits. Therefore, if I am required to repay my advanced educational assistance under the terms
of this contract, my subsequent enlistment in an Armed Service will not relieve me from my repayment
obligation.

6. ENLISTED ACTIVE DUTY SERVICE OBLIGATIONS. If I am called to active duty for breach of contract under
the provisions of paragraph 5, above, I will be ordered to active duty for one of the periods listed below, based
upon the year during which the breach occurs-

        a. During MS II, 2 years;

        b. During MS II, 3 years;
DA FORM 597-3, JUL 2005                                                                                             Page 6 of 8
                                                                                                                       APD 9V1.001
         PART II – AGREEMENT OF SCHOLARSHIP CADET CONTRACTING IN THE SENIOR PROGRAM (Continued)
        c. During MS IV, 4 years;

        d. After completion of MS IV, 4 years if I was a 2, 3, or 4-year scholarship recipient;

        e. Scholarship recipients who are granted extended scholarship benefits beyond 4 years incur an
additional active duty service obligation equivalent to the length of the extended period of scholarship benefits.

        f. Any unexpired portion of my enlistment obligation remaining after such active duty must be served
in a Reserve Component.

7. LEAVE OF ABSENCE, SUSPENSION OR TERMINATION OF SCHOLARSHIP BENEFITS. If my scholarship
benefits are temporarily inactivated by leave of absence or administrative suspension, or are terminated due
to my failure to meet academic or military retention standards fro scholarship cadets, as prescribed by law
Army regulations, or this contract; I will not be relieved of my obligation to the U.S. Army and my obligations
under this contract remain I effect. If my ROTC scholarship contract is terminated for any reason, but I am
qualified and am allowed to remain in the ROTC program as a nonscholarship cadet, I understand that I will not
be required to reimburse the United States for any financial assistance I received provided that I successfully
completed the ROTC program and all of the active duty and duty in a reserve status not on active duty for
which I am obligated under the provisions of this scholarship contract.

8. RELEASE FROM OBLIGATIONS. I understand that the Secretary of the Army or his/her designee may at
any time release me without notice from the obligations under this contract and disenroll me from the ROTC
Program without further benefits hereunder if, in the opinion of the Secretary of the Army or his or her
designee, it is in the best interest of the Army.

9. COMPLIANCE WITH AND CHANGES IN ELIGIBILITY REQUIREMENTS. I acknowledge that I have
discussed the eligibility requirements pertaining to enrollment in ROTC, enlistment in the USAR or ARNG, and
accepting a commission as an officer, with the PMS or other designated and authorized ROTC cadre member,
and that I understand these requirements. I realize that these requirements may change in the future. I agree
to keep myself apprised of all changes in requirements and to maintain my eligibility to participate in ROTC at
all times in the future. I also agree to inform the PMS of an change in my eligibility (medical and
non-medical) based on current or revised requirements as soon as I know or should have know of a change in
my eligibility status. Failure to so advise the PMS may result in disenrollment. Nothing in this paragraph
requires a disclosure in violation of the Department of Defense Homosexual Conduct Policy as addressed in AR
600-20.

10. DECLARATION OF BANKRUPTCY. I understand that the cost of my education under his program is, for
all purposes, a debt owed to the United States and entered into voluntarily on y part which, under the
provisions of Title 10, United States Code, Section 2005, Subsection (d), may not voluntarily be discharged by
my declaration of bankruptcy if less than five (5) years after the last day of the specified period of active duty.

11. ORDER TO ACTIVE DUTY IN THE EVENT OF A WAR. I understand that either as an enlisted member or
as a commissioned officer in the Reserve Component of the Army of the United States or upon my transfer or
assignment thereto, I may be ordered to active duty without my consent in the event of a war, a national
emergency declared by Congress or the President, an order of the Selected Reserve to active duty authorized
by the President, and as otherwise authorized by low, such call to active duty could be for the duration of a
war or any period of time authorized by law.

12. COMPLETE AGREEMENT AND SEVERABILITY. I understand the provisions in the contract contain the
only binding promises by and to both parties. This agreement controls over any conflicting advice or
information that I may have received orally or in writing from Cadet Command, my PMS, other cadre, cadets
or others regarding my obligations and agreements to the Army. If any provision within this agreement is
determined to be invalid or unenforceable by a court of law, the remaining terms and agreements remain in full
force and effect.

DA FORM 597-3, JUL 2005                                                                                               Page 7 of 8
                                                                                                                         APD 9V1.001
         PART II – AGREEMENT OF SCHOLARSHIP CADET CONTRACTING IN THE SENIOR PROGRAM (Continued)
N. HOME ADDRESS (Include Zip Code)                                   O. SIGNATURE

                                                                 0
                                                                     P. DATE (YYYMMDD)
,,


     PART III – CONSENT OF PARENT OR GUARDIAN TO CONTRACT IN ROTC AND ENLIST IN THE U.S. ARMY RESERVE
                   (To be completed if applicant is under 18 years of age at time of contracting in the ROTC program)
13. I certify that I am the applicant's parent or legal guardian, and that the applicant's date of birth as shown
above is correct.

14. I consent to applicant's enrollment in the ROTC and to enlistment in the USAR.

15. I have read and thoroughly understand the above statements of terms under which the applicant is being
enrolled, including all statues, directives, and regulations, incorporated by reference. I relinquish all claims to
applicant's service and to any wages or compensation for such service. I understand that the applicant will
be subject to all of the requirements and lawful commands of the officers who may from time to time be
placed over the applicant, and I certify that no promise or any kind has been made to me concerning the
applicant's assignment to duty or appointment as an officer as an inducement to me to sign this contract.

Q. SIGNATURE OF PARENT OR GUARDIAN                    R. SIGNATURE OF WITNESS                           S. DATE (YYYMMDD)



                      PART IV - CONFIRMATION OF ENROLLMENT AS AN ROTC SCHOLARSHIP CADET
                                  (And of Enrollment in the ROTC Program, If not previously enrolled)

16. On the basis of the above executed contract (Part II) , the above named                             T. EFFECTIVE DATE OF
applicant's selection for the award of the financial assistance indicated (Part I),                     ENROLLMENT (YYYYMMDD)
and the executed consent of the parent or guardian (Part III) , if applicable, I have
selected and enrolled this applicant as a cadet in the ROTC Program on the
effective date of enrollment in item T.
                                         PART V - FOR THE SECRETARY OF THE ARMY
U. NAME OF ROTC CONTRACTING OFFICIAL (Print or Type)                                                    W. DATE (YYYYMMDD)


V. SIGNATURE OF ROTC OFFICIAL




DA FORM 597-3, JUL 2005                                                                                                      Page 8 of 8
                                                                                                                                APD 9V1.001
                                                                                             NAME (LAST, FIRST MIDDLE)
                                                                                                                                                                            ,,

               Army Physical Fitness Test Scorecard                                          SSN                                                                                 GENDER
            For use of this form, see FM 21-20; the proponent agency is TRADOC

                                                                                             UNIT
                                                                                                                                    Stephen F. Austin State University
                   TEST ONE                                         TEST TWO                                                 TEST THREE                                               TEST FOUR
DATE             GRADE               AGE           DATE            GRADE               AGE              DATE                GRADE                AGE           DATE                  GRADE                AGE


HEIGHT (IN            BODY COMPOSITION             HEIGHT (IN          BODY COMPOSITION                 HEIGHT (IN                BODY COMPOSITION             HEIGHT (IN                  BODY COMPOSITION
INCHES)              WEIGHT:          BODY FAT:    INCHES)            WEIGHT:           BODY FAT:       INCHES)                  WEIGHT:          BODY FAT:    INCHES)                   WEIGHT:             BODY FAT:


                               lbs             %                                 lbs                %                                     lbs              %                                       lbs                %
                 GO / NO-GO          GO / NO-GO                    GO / NO-GO          GO / NO-GO                           GO / NO-GO           GO / NO-GO                          GO / NO-GO           GO / NO-GO


PU RAW SCORE         INITIALS         POINTS       PU RAW SCORE       INITIALS          POINTS          PU RAW SCORE             INITIALS         POINTS       PU RAW SCORE              INITIALS            POINTS



SU RAW SCORE         INITIALS         POINTS       SU RAW SCORE       INITIALS          POINTS          SU RAW SCORE             INITIALS         POINTS       SU RAW SCORE              INITIALS            POINTS



2MR RAW SCORE        INITIALS         POINTS       2MR RAW SCORE      INITIALS          POINTS          2MR RAW SCORE            INITIALS         POINTS       2MR RAW SCORE             INITIALS            POINTS



ALTERNATE AEROBIC EVENT               TOTAL        ALTERNATE AEROBIC EVENT              TOTAL           ALTERNATE AEROBIC EVENT                   TOTAL        ALTERNATE AEROBIC EVENT                       TOTAL
 EVENT                                POINTS        EVENT                               POINTS            EVENT                                   POINTS         EVENT                                       POINTS
   TIME                                               TIME                                                  TIME                                                    TIME
       GO        NO-GO                                    GO       NO-GO                                       GO           NO-GO                                     GO             NO-GO
NCOIC/OIC SIGNATURE                                NCOIC/OIC SIGNATURE                                  NCOIC/OIC SIGNATURE                                    NCOIC/OIC SIGNATURE


COMMENTS                                           COMMENTS                                             COMMENTS                                               COMMENTS




SPECIAL INSTRUCTION: USE INK                                                                                                              Data Required by the Privacy Act of 1974
LEGEND:         PU - PUSH UPS         2MR - 2 MILE RUN                                                  Title DA form 705                                  Individuals not providing information cannot be
                SU - SIT UPS          APFT - ARMY PHYSICAL FITNESS TEST                                 Authority 5 USC Section 301                        rated/scored. The principal purpose and routine use of
                                                                                                        Disclosure of requested information is             this information are to maintain a record of individual
                                                                                                        mandatory.                                         scores on physical fitness events.
DA FORM 705, JUNE 1999                                                      DA FORM 705, JUN 1998, MAY BE USED
                                                                                             NAME (LAST, FIRST MIDDLE)
                                                                                                                                                                            ,,

               Army Physical Fitness Test Scorecard                                          SSN                                                                                 GENDER
            For use of this form, see FM 21-20; the proponent agency is TRADOC

                                                                                             UNIT
                                                                                                                                    Stephen F. Austin State University
                   TEST FIVE                                         TEST SIX                                                TEST SEVEN                                               TEST EIGHT
DATE             GRADE               AGE           DATE            GRADE               AGE              DATE                GRADE                AGE           DATE                  GRADE                AGE


HEIGHT (IN            BODY COMPOSITION             HEIGHT (IN          BODY COMPOSITION                 HEIGHT (IN                BODY COMPOSITION             HEIGHT (IN                  BODY COMPOSITION
INCHES)              WEIGHT:          BODY FAT:    INCHES)            WEIGHT:           BODY FAT:       INCHES)                  WEIGHT:          BODY FAT:    INCHES)                   WEIGHT:             BODY FAT:


                               lbs             %                                 lbs                %                                     lbs              %                                       lbs                %
                 GO / NO-GO          GO / NO-GO                    GO / NO-GO          GO / NO-GO                           GO / NO-GO           GO / NO-GO                          GO / NO-GO           GO / NO-GO


PU RAW SCORE         INITIALS         POINTS       PU RAW SCORE       INITIALS          POINTS          PU RAW SCORE             INITIALS         POINTS       PU RAW SCORE              INITIALS            POINTS



SU RAW SCORE         INITIALS         POINTS       SU RAW SCORE       INITIALS          POINTS          SU RAW SCORE             INITIALS         POINTS       SU RAW SCORE              INITIALS            POINTS



2MR RAW SCORE        INITIALS         POINTS       2MR RAW SCORE      INITIALS          POINTS          2MR RAW SCORE            INITIALS         POINTS       2MR RAW SCORE             INITIALS            POINTS



ALTERNATE AEROBIC EVENT               TOTAL        ALTERNATE AEROBIC EVENT              TOTAL           ALTERNATE AEROBIC EVENT                   TOTAL        ALTERNATE AEROBIC EVENT                       TOTAL
 EVENT                                POINTS        EVENT                               POINTS            EVENT                                   POINTS         EVENT                                       POINTS
   TIME                                               TIME                                                  TIME                                                    TIME
       GO        NO-GO                                    GO       NO-GO                                       GO           NO-GO                                     GO             NO-GO
NCOIC/OIC SIGNATURE                                NCOIC/OIC SIGNATURE                                  NCOIC/OIC SIGNATURE                                    NCOIC/OIC SIGNATURE


COMMENTS                                           COMMENTS                                             COMMENTS                                               COMMENTS




SPECIAL INSTRUCTION: USE INK                                                                                                              Data Required by the Privacy Act of 1974
LEGEND:         PU - PUSH UPS         2MR - 2 MILE RUN                                                  Title DA form 705                                  Individuals not providing information cannot be
                SU - SIT UPS          APFT - ARMY PHYSICAL FITNESS TEST                                 Authority 5 USC Section 301                        rated/scored. The principal purpose and routine use of
                                                                                                        Disclosure of requested information is             this information are to maintain a record of individual
                                                                                                        mandatory.                                         scores on physical fitness events.
DA FORM 705, JUNE 1999                                                      DA FORM 705, JUN 1998, MAY BE USED
                     ADDENDUM TO CERTIFICATE AND ACKNOWLEDGEMENT OF SERVICE
        REQUIREMENTS (DA FORM 3540) FOR ALL PERSONNEL APPLYING FOR PARTICIPATION IN THE RESERVE
               OFFICERS TRAINING CORPS (ROTC)/ SIMULTANEOUS MEMBERSHIP PROGRAM (SMP)
                                          For use of this form, see AR 601-210; the proponent agency is DCS, G-1
                                                      INFORMATION REQUIRED BY THE PRIVACY ACT
AUTHORITY:               Title 10 USC Section 270, 10 USC 511, 10 USC 673a and Executive Order 9397, 22 November 1943.
PRINCIPAL PURPOSE:       To explain additional obligations and participation requirements imposed as a result of this specific option and to
                         insure that your agreement to these conditions is a matter of record.
ROUTINE USES:            Confirmation of obligations and participation requirements incurred under this option; occasionally as a basis for
                         removal from the program if the requirements are not met.
DISCLOSURE:              Disclosure of your SSN is voluntary; however, if not provided you will not be accepted into the program.
                                                                        APPLICABILITY
This addendum to DA Form 3540 will be completed by all individuals applying for participation in the ROTC/SMP and will be reproduced
locally
                                                     INSTRUCTIONS TO USAR ACCEPTANCE OFFICIAL
Each individual applying for participation in the ROTC/SMP will read, initial where indicated, and sign this addendum prior to participating in
the program is they are currently unit members, or prior to being enlisted, reenlisted, extended, or reassigned, as a member of a troop program
unit of the USAR. All questions will be answered to the applicant's satisfaction. After completion of the Authentication block below, a copy of
this Addendum will be attached firmly to each copy of the DA Form 3540 and distributed in accordance with the instructions contained in Section
IV, Chapter 8, AR 140-111.
                                                                EXPLANATION TO APPLICANT
1. In connection with my selection for participation in the ROTC/SMP as a currently assigned unit member, or in connection with my enlist-
ment, reenlistment, extension of enlistment, or reassignment from Control Group (ROTC) to a troop program unit of the US Army Reserve, I
accept the following

       Option 1: Selection for participation in ROTC/SMP as a member currently assigned to the appropriate troop program unit. I further
acknowledge that (check one):

             I have previously successfully completed a basic training course conducted by the US Armed Forces; or I have successfully com-
pleted 3 years or more of Junior ROTC and a letter of acceptance by a Professor of Military Science as credit placement for enrollment in
Advanced ROTC has been issued and is available to the recruiting officials; or I have attended a Service Academy for one year; or I have
successfully completed MS II; or I have successfully completed ROTC Basic Camp. Read and initial paragraphs 2a through 2f, h, I, j, l and m.

             Entry on Initial Active Duty for Training (IADT) to complete basic training is required to be successfully completed prior to
entrance in ROTC/SMP. Read and initial paragraphs 2a through 2f, h, I, j, l, and m.

        Option 2: Enlistment for ROTC/SMP with no previous military service or ROTC credit placement for enrollment in Advanced ROTC.
Entry on Initial Active Duty for Training (IADT) to complete basic training is required to be successfully completed prior to entrance in ROTC/
SMP. Read and initial paragraphs 2a through g, I, j, k, and m.

        Option 3: Enlistment, reenlistment, or extension of enlistment, for ROTC/SMP with one of the following:
                  a. Previous military service and have successfully completed a basic training course conducted by US Armed Forces.
                 b. Have successfully completed 3, or more, years of Junior ROTC and a letter of acceptance by a Professor of Military Science
as credit placement for enrollment in Advanced ROTC, has been issued an is available to the recruiting officials.
                  c. Have attended a Service Academy for one year.
                  d. Have successfully completed MS II.
                  e. Have successfully completed ROTC Basic Camp.
        Read and initial each paragraph 2a through 2m.

         Option 4: Reassignment from Control Group (ROTC) to a troop program unit for participation in ROTC/SMP and already enrolled and
participating in the Advanced ROTC Program. Read and initial paragraphs 2a, b, c, d, I, j, k, and m.
2. In connection with my enlistment, reenlistment, extension of enlistment, or reassignment from Control Group (ROTC) , the following
additional agreements are acknowledged:
        a. I understand the ROTC/SMP is a voluntary officer training program which requires Reserve Component enlistment status for eligibility.
        b. I understand that by law (10 USC 2106) a commissioned officer may not apply credits which stem from enlisted service served
concurrently with ROTC Advanced Course training, when computing length of service for any purpose.
         c. I understand that participation in the Army ROTC scholarship program are not eligible for participation in ROTC/SMP. ROTC/SMP
participation may apply for Army ROTC scholarships; however, they will be reassigned from the troop program unit to the Control Group (ROTC)
prior to acceptance of such scholarships.
        d. I agree that upon successful completion of the ROTC Advanced Course, to include ROTC Advanced Camp, I will volunteer for
commissioning under the provisions of the ROTC Early Commissioning Program (ECP) if, upon completion, I am not scheduled to receive a
baccalaureate degree within six months.
        e. I am not eligible to enroll in the Advanced ROTC Program as provided in paragraph 3-14, AR 145-1.

                                                                                                                                                   USAPA VI.00
DA FORM 4824-R, 1 APR 2005
        f. I understand if I am accepted for participation in the ROTC/SMP and do not apply for enrollment in the ROTC Advanced Course
within one year following enlistment, I will be dropped as a potential ROTC/SMP participant and retained in the unit in an enlisted status until
completion of my military service obligation (statutory or contractual) . I will also be required to undergo any initial active duty for training not
previously completed.
        g. I understand if I enlist directly for participation in the ROTC/SMP and I apply but am not accepted for enrollment in the ROTC
Advanced Course (see eligibility requirements, paragraphs 3 51 and 3-17, AR 145-1) . I will, at my request be retained in the unit, or be honorably dis-
charged. If I am retained in an enlisted status, I will be dropped as a potential ROTC/SMP participant and required to complete an initial
active duty for training not previously completed.
         h. I understand if I enlisted under any other enlistment program or option and was selected for ROTC/SMP participation and I do not
apply for enrollment in the ROTC Advanced Course within on year following my selection, or I am not accepted for enrollment in the ROTC
Advanced Course, I will be dropped as a potential ROTC/SMP participant and retained in an enlisted status until completion of my military
service obligation (statutory or contractual) .
          i. I understand that if I am disenrolled from Advance ROTC, or fail to complete the ROTC Advance Course, I will be dropped from
the ROTC/SMP and, if otherwise qualified, retained in the unit in an enlisted status until completion of my military service obligation (statutory
or contractual) . I must undergo initial duty for training if not previously completed. I will be administratively reduced immediately to
the grade and rank authorized by AR 140-158.
        j. I understand that if I fail to volunteer for the ROTC Early Commissioning program (ECP) , or fail to accept a commission, or fail to be
tendered a commission, I will be treated in the same manner as those ROTC/SMP participants who fail to complete Advanced ROTC. See
paragraph i above.
        k. I understand that when enlisting directly for participation in the ROTC/SMP I am not entitled to enlistment incentives under the
provisions of DA Circular 135-23, or similar Federal directives.
         l. I understand that when entering the ROTC/SMP if I received an enlistment incentive under the provisions of DA Circular 135-23, or
similar Federal directives, I will not be entitled, upon my assignment to an officer-trainee position, to future incentive payments and may be
required to pay back some, or all, of the money I have received prior to my assignment to an officer-trainee position.
       m. I understand that any enlistment/reenlistment program, other than the Enlistment Incentive Program (DA Circular 135-23, or other
                       which I would have otherwise elected and been eligible for upon initial enlistment/reenlistment, will be available upon
similar Federal directives) ,
my application for said program should I remain in an enlisted status upon removal from the ROTC/SMP.

3. I have read, initialed, and understood, each of the statements above which pertain to the option I chose in paragraph 1 above. Any other
promise, representation, or commitment made to me in conjunction with my enlistment, reenlistment, extension of enlistment or reassignment
from Control Group (ROTC), for participation in the Reserve Officers Training Corps (ROTC)/Simultaneous Membership Program (SMP)
below in my own handwriting, or is hereby waived. (If none, write "NONE".)




                                                                            AUTHENTICATION
ASSIGNED UNIT DESIGNATION AND COMPLETE ADDRESS (Includes ZIP Code)




DATE                            TYPED NAME AND SOCIAL SECURITY NUMBER OF APPLICANT                    SIGNATURE OF APPLICANT




DATE                            TYPED NAME GRAD, BRANCH AND TITLE OF RECRUITING OFFICIAL              SIGNATURE OF RECRUITING OFFICIAL



                                                                                                                                                           USAPA VI.00
DA FORM 4824-R, APR 2005
                                      STATEMENT OF UNDERSTANDING (DEPENDENCY)
                                 For use of this form, see CC Pam 145-4, the proponent agency is ATCC-PC


                                       DATA REQUIRED BY THE PRIVACY ACT OF 1974

Authority                   10 USC 2101 and 2107
Principal Purpose           To establish an understanding between a cadet and Army ROTC in regards to dependency
                            and the program requirements
Routine Uses                To provide a statement of understanding concerning dependency for participation in Army ROTC
Disclosure                  Disclosure is voluntary.


                                         PART I - STATEMENT OF UNDERSTANDING


 "I,           ,,                                                                                                      ,
                                                       (enter cadet's name)
 am the parent of,
                                                                 (enter child(ren)'s name(s))
 and certify that the child(ren) has (have) been placed in the custody of the other parent or another adult
 by court order or as provided by state law. I further certify that this custody agreement is intended to
 remain in full force and effect during the term for which I am now enrolling. I understand that if I regain
 custody of this (these) child(ren) , either by court decree, or in accordance with applicable state law, or
 if the child(ren) are residing with me in lieu of the legal guardian, I will be processed for disenrollment
 from the program unless I can show that regaining custody is not contrary to the above stated intent:

 (e.g., death or incapacity of other parent or custodian) ."

 My child(ren) is (are) in the custody of:
                                                                                (Name of person with custody)



                     (Relationship)                                                           (Address of person with custody)



                                                                                             (City, State, Zip Code for address)


 I hereby certify that no person, agency or member of the Army, to include my recruiter or enrollment
 officer has required me to give up custody of my child(ren) as a condition for enrollment. I understand
 that the Army merely recognizes that some persons for personal reasons may have relinquished custody
 of their child or children.

 I further state that no person, agency or member of the Army has advised me that I will be allowed
 to regain custody of my child(ren) while in the ROTC program nor has given me any perception or
 assurance that the policy stated above is waivable or not upheld once enrolled.



                                                                                                   (Signature of Applicant)


                                                       PART II - CERTIFICATION

 I certify that the above sworn statement was duly taken and subscribed in my presence at

                                                               this                         day of
             (enter the name of the School)                              (enter day)                              (enter month and year)




                                                                              (Signature of PMS or Enrollment Eligibility Officer)


CC FORM 132-R, DEC 2007                                   PREVIOUS EDITIONS ARE OBSOLETE
                                   GUARANTEED RESERVE FORCES DUTY (GRFD)
                                NON-SCHOLARSHIP CADET CONTRACT ENDORSEMENT
                               For use of this form, see CC Reg 145-10, the proponent agency is ATCC-OI-R


                                      DATA REQUIRED BY THE PRIVACY ACT OF 1974

Authority                   10 USC 2101, 2103, 2104, 2107, 2107A, 2111 and 5 USC 301.2
Principal Purpose           To specify the contractual agreements and obligations and to document contracting in the Army
                            Senior ROTC GRFD Non-Scholarship Program.
Routine Uses                This form will be maintained in the cadet's Military Personnel Records Jacket and becomes a
                            permanent part of the Official Military Personnel File as confirmation of enrollment, contracting,
                            obligation, and agreements.
Disclosure                  Disclosure of the information requested in this endorsement is voluntary. However, applicable
                            portions must be completed if the applicant desires to be contracted in the Army Senior ROTC
                            GRFD Non-Scholarship Program.


                                                    CONTRACT ENDORSEMENT
A. STUDENT'S NAME (Last, First, MI)                                      B. SSN


,,
C. NAME OF EDUCATIONAL INSTITUTION                                       D. ADDRESS OF EDUCATIONAL INSTITUTION
                                                      P.O. Box 13059, SFA Station
                                                      P.O. Box 13059, SFA Station
                                                      Nacogdoches,TX 75962
   PART I - AGREEMENT OF GRFD NON-SCHOLARSHIP CADET CONTRACTING IN THE SENIOR ROTC
                                                PROGRAM
1. This endorsement becomes a part of the Army Senior Reserve Officers' Training Corps Non-Scholarship
Cadet Contract (DA Form 597) between the Cadet and the Professor of Military Science on behalf of
the Secretary of the Army.

2. The Secretary of the Army agrees that under present circumstances, my service on active duty will not
be required upon completion of my degree requirements and successful completion of the Senior Reserve
Officers' Training Corps (SROTC). I will instead serve an initial period of active duty for training (ADT),
and remain a satisfactory participant in the Reserve Components (RC) for the period specified in Part I
of my ROTC Cadet Contract. Applicable laws and regulations will govern my services in the RC.

3.   As a GRFD Non-Scholarship Cadet (including Military Junior College cadets), I agree to the following:

               To participate in the Simultaneous Membership Program (SMP). The PMS will assist me in
              a.
locating a RC unit within reasonable commuting distance (AR 140-10). If no vacancy is immediately
available, I will continue to seek assignment to a RC unit. I will complete all ROTC requirements and a
baccalaureate degree.

         b. I further understand that I will not be commissioned under the provisions of the Early
Commissioning Program (ECP) unless I am a graduate of a Military Junior College (MJC) .

               If I wish to revoke this GRFD endorsement, I understand that I must submit a CC Form 204-R
              c.
(Revocation of the Guaranteed Forces Duty Contract Endorsement) through the PMS at my college or
university to HQ, USACC.

             Request for revocation must be approved by a HQ, USACC, representative and submitted
              d.
with my accession packet. I understand that based upon the needs of the service, HQ, USACC, may not
approve my request to revoke this endorsement.


CC FORM 202-R, JAN 05                                     PREVIOUS EDITIONS ARE OBSOLETE
     PART I - AGREEMENT OF GRFD NON-SCHOLARSHIP CADET CONTRACTING IN THE SENIOR ROTC
                                     PROGRAM (Continued)

            e. Should I request to revoke my GRFD endorsement and it is favorably considered, I will be
considered for accession onto active duty by the DA/ROTC Selection Board. If I have received benefits
from the Selected Reserve Montgomery GI Bill (SR MGIB) , Kicker, federal tuition assistance, or ARNG
State tuition assistance programs as an SMP participant and selected for active duty, that I may be subject
to recoupment of those benefit payments.

4. Upon completion of the SROTC Program and receipt of a baccalaureate degree, I may be commissioned
in the United States Army Reserve (USAR) and where possible, assigned to a USAR unit or appointed in
the Army National Guard (ARNG) for assignment to an ARNG unit. I will then be obligated to serve an
initial period of ADT and perform the remainder of my service obligation in the RC, as governed by
applicable laws and regulations (AR 135-91). If assigned to an RC unit, I will attend required drill periods and
an annual ADT. I will be required to travelwithin a 50-mile radius to participate in required drill sessions
(AR 140-10).

5. After commissioning and OBC attendance, if I am not initially assigned to a RC unit, I will be
assigned to the USAR Control Group (AT) . I understand that while so assigned, I will be subject to
mandatory assignment, at any time, to an RC unit. As a member of the USAR Control Group (AT) , I will be
liable for a prescribed period of annual ADT (presently not more than 30 days a year).

6.Terms of this agreement may be modified, following either statutory change or a Secretary of the Army
determination that the needs of the Army so require.


E. CADET'S SIGNATURE                                                               F. DATE



       PART II - CONFIRMATION OF ENROLLMENT AS AN ROTC GRFD NON-SCHOLARSHIP CADET
G. NAME AND GRADE OF PROFESSOR OF MILITARY SCIENCE (PMS)       (Print or Type)     H. DATE



I. SIGNATURE OF PROFESSOR OF MILITARY SCIENCE (PMS)                                J. GRFD CONTROL NUMBER



K. REMARKS




CC FORM 202-R, JAN 05 (Back)                  PREVIOUS EDITIONS ARE OBSOLETE
                                       GUARANTEED RESERVE FORCES DUTY (GRFD)
                                      SCHOLARSHIP CADET CONTRACT ENDORSEMENT
                               For use of this form, see CC Reg 145-10, the proponent agency is ATCC-OI-R

                                       DATA REQUIRED BY THE PRIVACY ACT OF 1974

Authority                   10 USC 2101, 2103, 2104, 2107, 2107A, 2111 and 5 USC 301.2
Principal Purpose           To specify the contractual agreements and obligations and to document contracting in the Army
                            Senior ROTC GRFD Scholarship Program.
Routine Uses                This form will be maintained in the cadet's Military Personnel Records Jacket and becomes a
                            permanent part of the Official Military Personnel File as confirmation of enrollment, contracting,
                            obligation, and agreements.
Disclosure                  Disclosure of the information requested in this endorsement is voluntary. However, applicable
                            portions must be completed if the applicant desires to be contracted in the Army Senior ROTC
                            GRFD Scholarship Program.

                                                   CONTRACT ENDORSEMENT
A. STUDENT'S NAME (Last, First, MI)                                      B. SSN



C. NAME OF EDUCATIONAL INSTITUTION                                       D. ADDRESS OF EDUCATIONAL INSTITUTION




                   PART I - AGREEMENT OF GRFD SCHOLARSHIP CADET CONTRACTING
                                    IN THE SENIOR ROTC PROGRAM
1. This endorsement becomes a part of the Army Senior Reserve Officers' Training Corps Scholarship
Cadet Contract (DA Form 597-3) between the Cadet and the Professor of Military Science on behalf of
the Secretary of the Army.

2. The Secretary of the Army agrees that under present circumstances, my service on active duty will not
be required upon completion of my degree requirements and successful completion of the Senior Reserve
Officers' Training Corps (SROTC). I will instead serve an initial period of active duty for training (ADT),
and remain a satisfactory participant in the Reserve Components (RC) for the period specified in Part I
of my ROTC Cadet Contract. Applicable laws and regulations will govern my services in the RC.

3.   As a GRFD Scholarship Cadet (including Military Junior College cadets), I agree to the following:

            a. To participate in the Simultaneous Membership Program (SMP). The PMS will assist me in
locating a RC unit within reasonable commuting distance (AR 140-10) that has a valid officer training
vacancy and accepts me into the unit. If no vacancy is available, I will continue to seek participation in a
RC unit until I find a unit vacancy. I will complete all ROTC requirements, complete a baccalaureate degree,
and commission.

             b. I will not be commissioned under the provisions of the Early Commissioning Program (ECP)
if I am not a graduate of a Military Junior College (MJC) .

              I may not revoke this GRFD endorsement and apply for accession into active duty, or any
              c.
other active duty education delay program, to include Health Professions Scholarship Program (HPSP)
(unless I am a Military Junior College Cadet).
                                                                 (Initials)

            d. If I am a Dedicated Army National Guard Scholarship Cadet (including Military Junior
College (MJC) cadets), I further understand and agree that upon commissioning, my military service
obligation, after an initial ADT period, can only be fulfilled through service in the Army National Guard
(ARNG) .
                                                                      (Initials)
CC FORM 203-R, FEB 05                            PREVIOUS EDITIONS ARE OBSOLETE
                  PART I - AGREEMENT OF GRFD SCHOLARSHIP CADET CONTRACTING
                              IN THE SENIOR ROTC PROGRAM (Continued)

4. Upon completion of the SROTC Program and receipt of a baccalaureate degree (associate degree for
MJC graduates), I will be commissioned in the United States Army Reserve (USAR) and where possible,
assigned to a USAR unit or appointed in the Army National Guard (ARNG) for assignment to an ARNG unit.
I will then be obligated to serve an initial period of ADT and perform the remainder of my service
obligation in the RC, as governed by applicable laws and regulations (AR 135-91). If assigned to an RC
unit, I will attend required drill periods and an annual ADT. I will be required to travel within a 50-mile
radius to participate in required drill sessions (AR 140-10).

5.After commissioning and OBC attendance , if I am not initially assigned to a RC unit, I will be
assigned to the USAR Control Group (AT) . I understand that while so assigned, I will be subject to
mandatory assignment, at any time, to an RC unit. As a member of the USAR Control Group (AT) , I am
obligated to serve a period of ADT. On completion of this initial ADT, I will be liable for a prescribed
period of annual ADT (presently not more than 30 days a year).

6.Terms of this agreement may be modified, following either statutory change or a Secretary of the Army
determination that the needs of the Army so require.


E. CADET'S SIGNATURE                                                             F. DATE



         PART II - CONFIRMATION OF ENROLLMENT AS AN ROTC GRFD SCHOLARSHIP CADET
G. NAME AND GRADE OF PROFESSOR OF MILITARY SCIENCE (PMS)      (Print or Type)    H. DATE



I. SIGNATURE OF PROFESSOR OF MILITARY SCIENCE (PMS)                              J. GRFD CONTROL NUMBER



K. REMARKS




CC FORM 203-R, FEB 05 (Back)                 PREVIOUS EDITIONS ARE OBSOLETE
                         REVOCATION OF THE GUARANTEED RESERVE FORCES DUTY (GRFD)
                              NON-SCHOLARSHIP CADET CONTRACT ENDORSEMENT
                                For use of this form, see CC Reg 145-10, the proponent agency is ATCC-OI-R


                                      DATA REQUIRED BY THE PRIVACY ACT OF 1974

Authority                    10 USC 2101, 2103, 2104, 2107, 2107A, 2111 and 5 USC 301.2
Principal Purpose            To obtain personal data in order to revoke a GRFD Cadet Contract Endorsement for a cadet
                             participating in the Senior ROTC program.
Routine Uses                 This form will be maintained in the cadet's Military Personnel Records Jacket and becomes a
                             permanent part of the Official Military Personnel File as confirmation of enrollment, contracting,
                             obligation, and agreements.
Disclosure                   Disclosure is voluntary. However, failure to provide complete information and provide responses
                             will suspend cadet's request for a GRFD Control Number revocation.


                                         GRFD REVOCATION REQUEST
TO              Commander, U.S. Army Cadet Command    FROM
                ATTN: ATCC-OI-R
                Fort Monroe, VA 23651-5000


                                               PART I - CADET'S PERSONAL DATA

IAW Cadet Command Regulation 145-10, I hereby request that my Guaranteed Reserve Forces Duty
(GRFD) Contract Endorsement to my Senior ROTC Cadet Contract be revoked so that I may apply and be
considered for active duty.

1a. NAME (Last, First, MI)                                                               1b. SSN


,,
2. GRFD CONTROL NUMBER                                                                   3. HOST INSTITUTION AND FICE CODE


                                                                                        Stephen F. Austin State University
                                                                                        003624

4a. CADET'S SIGNATURE                                                                    4b. DATE



                       PART II - PROFESSOR OF MILITARY SCIENCE (PMS) RECOMMENDATION
The cadet does not have a GRFD or Dedicated ARNG Scholarship.
I recommend approval/disapproval (circle one) of the above cadet's request.
5a. PROFESSOR OF MILITARY SCIENCE (PMS) SIGNATURE                                        5b. DATE



                        PART III - HEADQUARTERS, CADET COMMAND DECISION
Revocation of the above named cadet's GRFD Cadet Contract Endorsement is approved/disapproved
(circle one) .

6a. NAME AND GRADE OF HQ, CADET COMMAND REPRESENTATIVE                                   6b. DATE



6c. HQ, CADET COMMAND REPRESENTATIVE SIGNATURE                                           7. NEW CONTROL NUMBER



CC FORM 204-R, JAN 05                                      PREVIOUS EDITIONS ARE OBSOLETE
                 REQUEST FOR CONVERSION TO GUARANTEED RESERVE FORCES DUTY (GRFD)
                       OR DEDICATED ARMY NATIONAL GUARD (ARNG) SCHOLARSHIP
                                For use of this form, see CC Reg 145-10, the proponent agency is ATCC-OI-R


                                      DATA REQUIRED BY THE PRIVACY ACT OF 1974

Authority                    10 USC 2101, 2103, 2104, 2111 and 5 USC 301.2
Principal Purpose            To obtain personal data in order to request conversion to a GRFD or Dedicated ARNG Scholarship
                             for a cadet participating in the Senior ROTC program.
Routine Uses                 To provide information for use in converting to a GRFD or Dedicated ARNG Scholarship.
Disclosure                   Disclosure is voluntary. However, failure to provide complete information and provide responses
                             will suspend cadet's request for conversion to a GRFD or Dedicated ARNG Scholarship.


                                            CONVERSION REQUEST
TO              Commander, U.S. Army Cadet Command    FROM
                ATTN: ATCC-OI-R
                Fort Monroe, VA 23651-5000



IAW Cadet Command Regulation 145-1, request my scholarship offer be converted to
(GRFD USAR/ GRFD ARNG/ or Dedicated ARNG ) (circle one) . I understand that I must join an appropriate
Reserve Component (RC) unit and be a member of the Simultaneous Membership Program (SMP) .

1a. NAME (Last, First, MI)                                                             1b. SSN



2. HOST INSTITUTION & FICE CODE            2a. ACADEMIC MAJOR                          3. SOURCE/TYPE OF CURRENT SCHOLARSHIP
Stephen F. Austin State University
003624

4a. CADET'S SIGNATURE                                                                  4b. DATE



                       PART II - PROFESSOR OF MILITARY SCIENCE (PMS) RECOMMENDATION

I recommend approval/disapproval (circle one) of the above cadet's request.

5a. PROFESSOR OF MILITARY SCIENCE (PMS) SIGNATURE                                      5b. DATE



6. REMARKS




CC FORM 226-R, JAN 05                                    PREVIOUS EDITIONS ARE OBSOLETE
              REQUEST FOR GUARANTEED RESERVE FORCES DUTY (GRFD) CONTROL NUMBER
                               For use of this form, see CC Reg 145-10, the proponent agency is ATCC-OP-I-I


                                      DATA REQUIRED BY THE PRIVACY ACT OF 1974

Authority                    10 USC 2101, 2103, 2104, 2107, 2107A, 2111 and 5 USC 301.2
Principal Purpose            To obtain personal data in order to authorize a GRFD Cadet Contract Endorsement for a
                             non-scholarship cadet participating in the Senior ROTC program.
Routine Uses                 To provide information for use in issuing a GRFD Control Number.
Disclosure                   Disclosure is voluntary. However, failure to provide complete information and provide responses
                             will suspend cadet's request for a GRFD Control Number.


1. TO           Commander, U.S. Army Cadet Command                       2. FROM     Professor of Military Science
                ATTN: ATCC-OP-I-I
                Fort Monroe, VA 23651-5000



IAW Cadet Command Regulation 145-10, request a GRFD Control Number be issued to the following
cadet:

3a. NAME (Last, First, MI)                                                             3b. SSN



4. ADVANCED COURSE ENROLLMENT DATE                                                     5. ACADEMIC MAJOR AND CODE



6. HOST INSTITUTION AND FICE CODE                                                      7. COMMISSION/GRADUATION DATE


Stephen F. Austin State University                                003624


8.This cadet was/was not (circle one) released IAW AR 635-200, Chapter 16, para 2c, as part of the Green to Gold
Program.


9. This cadet meets all eligibility requirements for Advanced Course enrollment and the GRFD Program.
I support this request.


10.   This cadet understands that he/she must participate in the Simultaneous Membership Program (SMP) .

11a. SMP INFORMATION: (Circle One)                                     11b. SMP UNIT:

                ARNG                       USAR
12. REMARKS




13a. PROFESSOR OF MILITARY SCIENCE (PMS) SIGNATURE                                                   13b. DATE




CC FORM 227-R, OCT 03                                    PREVIOUS EDITION IS OBSOLETE
                                                                                                                                         PAGE 1 OF 3
                                           ANNEX     DD FORM 4/DA FORM 4836
                                      SIMULTANEOUS MEMBERSHIP PROGRAM AGREEMENT
                                                 ARMY NATIONAL GUARD

                                (For use of this Form, see NGR 600-200 the proponent agency is NGB-ARP-PE)
                                                        PRIVACY ACT STATEMENT
     Authority: Section 12101 and 12103, Title 10, USC, and Section 301 and 304, Title 33, USC.
     Purpose: To amend original enlistment, reenlistment, or extension of agreement.
     Use:: This amendment becomes a part of the DD Form 4/DA Form 4836 which establishes the agreements and understandings between the
            Army National Guard and the individual participation under the ROTC Simultaneous Membership Program.
     Mandatory Disclosure: Individual could be denied participation under the Simultaneous Membership Program if not completed.
A.                                                  AGREEMENTS

          1. I hereby agree to amendment of my previous Agreement as follows and understand that -

            a. I (am) (am not) required to complete basic training prior to enrollment in the Advanced
          ROTC Course.

             b. I am required to apply for enrollment in the Advanced ROTC Course, if not already
          enrolled, within 1 year from the date of this Amendment.

              c. Should I be a member of the USAR Control Group (ROTC), I will be discharged from the
          USAR Control Group (ROTC), I will be discharged from the USAR Control Group (ROTC) and
          transferred for enlistment / reenlistment in the ARNG.

              d. Should I later be awarded an Army ROTC scholarship, which does not provide for
          Reserve Forces Duty (RFD), or is not a 2 year Junior Military College Scholarship, I will be
          discharged from the ARNG and transferred for assignment to the USAR Control Group (ROTC)
          prior to acceptance of such scholarship.


          e. I may not, when a commissioned officer, apply credits which stem from enlisted service
          performed concurrently with Advanced ROTC Course training toward computation of length of
          service for any purpose.

          f. I will volunteer for commissioning under the ROTC Early Commissioning Program if upon
          completion of the ROTC Advance Course I am not scheduled to receive, within 8 months, a
          baccalaureate degree.


          g. Upon becoming an SMP participant, I must have 4 years remaining on my original or
          extended enlistment / reenlistment contract in the Selected Reserve from date of enrollment in the
          SMP.

          h. Unless I obtain a Guaranteed Reserve Forces Duty (GRFD) contract prior to enrollment in
          Advanced ROTC, I will serve with the ARNG after commissioning until I obtain a baccalaureate
          degree. Upon obtaining the degree, I will then be selected for either Reserve Forces Duty of
          Extended Active Duty according to the needs of the service.


          2. Addition details of my participation in the SMP are in Section                                                                 .


NGB FORM 594-1, APRIL 1997, (EF) ( ADOBE V. 4.0)
                                                                                                                     PAGE 2 OF 3
B.                           FOR ALL DIRECT SMP ENLISTMENTS / REENLISTMENTS


        3. My enlistment / reenlistment in the ARNG is for the purpose of directly participating in the
        Simultaneous Membership Program. As a participant in the SMP, I understand that -


                        a. If I fail to apply for enrollment in the Advanced ROTC Course, as required I will -


                                (1) Be deleted from the SMP
                                (2) Be retained in the enlisted grade held prior to participation in the SMP
                                (3) Be required to execute the terms of my enlistment / reenlistment agreement
                                excluding this amendment, and
                                (4) Complete Basic Training (BT) and Advanced Individual Training (AIT) if
                                not previously completed.


                        b. If I apply for enrollment in the Advanced ROTC Course, but fail to be accepted, then
                        I may -


                                (1) Elect deletion from the SMP in order to continue in an enlisted status as if I
                                had failed to apply for enrollment (para. 3a, above), or
                                (2) Elect discharge as a Reserve of the Army and as a member of the ARNG.


                          c. If I am enrolled in the Advanced ROTC Course and fail to volunteer for ECP, and as
        required, fail to accept a commission or fail to be tendered a commission, then I will be deleted from
        the SMP and be required to continue in an enlisted status as if I had failed to apply for enrollment
        (para. 3a, above).

C.                     FOR CURRENT ARNG MEMBERS ELECTING PARTICIPATION IN SMP


        4. As a current ARNG member, my original enlistment / reenlistment agreement is to be held in
        abeyance in order that I may participate in the SMP. As a participant in the SMP, I understand that -


                        a . Upon acceptance into SMP, I am not eligible to continue in the ARNG Incentive
        Program. I will not be entitled to further incentive payments. Acceptance into the SMP does not
        constitute a condition where recoupment of incentive payments is required.


                        b. If I am disenrolled from or I fail to complete the Advanced ROTC Course, of fail to
        be tendered a commission or accept a commission, or fail to volunteer for the ROTC Early
        Commissioning Program, then provisions of para. 3a, above, apply.




NGB FORM 594-1, APRIL 1997
                                                                                                                     PAGE 3 OF 3
D.                                     CONFIRMATION OF SMP AGREEMENT


         5. My acceptance into the SMP is based on my desire to volunteer for the program which requires
         enlisted status for eligibility.


         6. I certify that I have carefully read this document. Any questions I had were explained to my
         satisfaction, I fully understand that "ONLY THOSE AGREEMENTS IN SECTION A AND
                   OF THIS DOCUMENT OR THOSE RECORDED AND ACKNOWLEDGED BY ME.
         WILL BE HONORED. ANY OTHER PROMISES OR GUARANTEES MADE TO ME BY
         ANYONE ARE WRITTEN BELOW." (Include brief description of an recorded document other
         than this agreement; IF NONE, check "NONE" and initial).


          NONE
                                                   Initials of Applicant




E.                                             AUTHENTICATION
     Signature of Unit Commander                                           Signature of Unit Commander



     Date, Typed Name of Unit Commander                                         Grade                    SSN




     Unit For Which Enlisted (Include Officer Trainee                           Unit Address
     Position Paragraph and Line Number




NGB FORM 594-1, APRIL 1997
                                 ANNEX      (SUPPLEMENTAL) TO DD FORM 4
              STATEMENT OF UNDERSTANDING -THE ARMY NATIONAL GUARD (ARNG) MONTGOMERY GI BILL
                                      KICKER PROGRAM (10 USC 16131)
                     For use of this form, see AR 135-7; the proponent agency is ODCSPER.
                                DATA REQUIRED BY THE PRIVACY ACT OF 1974
AUTHORITY:                  Title 10, USC, chapter 1606, Title 5, USC and section 552a
PRINCIPAL PURPOSE:          To explain obligation and eligibility requirements for
                            entitlement under the Selected Reserve Montgomery GI Bill (MGIB-
                            SR) (10 USC 16131) and to ensure that your understanding of these
                            conditions is a matter of record.
ROUTINE USES:               To record your eligibility, prescribe your entitlement, and
                            provide you with the contract terms of the MGIB-SR Kicker.
DISCLOSURE:                 Disclosure of your SSN is voluntary. If you do not complete
                            this form you cannot participate in the MGIB-SR Kicker
                            Program.

                                           SECTION I - APPLICABILITY

All eligible enlisted soldiers who enlisted, reenlisted, or extended in the Army National Guard for
MGIB-SR Kicker benefits between 1 October 1998 and 30 September 1999 and who enroll in either the
State Officer Candidate School (OCS) Program or the Simultaneous Membership Program (SMP), or
completed the Federal OCS Program after 30 September 1999. Eligible soldiers will complete this
statement of understanding immediately upon swearing to or affirming the oath of reenlistment or
extension. This supplemental statement of understanding will be completed by soldiers reenlisting
or extending for the MGIB-SR Kicker Program at the adjusted rate.

                                           SECTION II - INSTRUCTIONS

The service representative will read and explain the MGIB-SR Kicker requirements outlined on this
form and staple a copy of this form (initialed, signed and dated) to the original Kicker contract.

                                SECTION III - ACKNOWLEDGMENT/ELIGIBILITY
In connection with my reenlistment or extension in the Army National Guard for entitlement to the
MGIB-SR Kicker at an increased rate, I hereby acknowledge eligibility by my initials and signature
that I meet the following eligibility criteria:

          a. I am a Prior Service soldier participating in a State OCS program currently in phase
II or III (completed the first Annual Training Period) or currently contracted as an ROTC SMP (MS
III or IV) in the ARNG __________; or
                        (initials)
          b. I completed the Federal OCS Program on or after 1 October 1999 and accepted a
commission is the ARNG ___________; and
                       (initials)

          c. I agree to sign a DA Form 5447-R, Officer Service Agreement, equal to the number of
months remaining for the six-year obligation that entitled me to MGIB-SR Kicker benefits as an
Officer ___________.
         (initials)
                                       SECTION IV-OBLIGATION

I agree to participate satisfactorily in the ARNG for six years according to the conditions
prescribed for the MGIB-SR Kicker Program_________.
                                         (initials)

                                           SECTION V - ENTITLEMENT

1. I am entitled to the MGIB-SR Kicker Program in the amount of $                per month for
each month of basic MGIB-SR, Chapter 1606 or Chapter 30 eligibility remaining for full time
enrollment for a maximum of 36 academic months. The Department of Veterans Affairs (DVA) will
adjust this amount and the number of months for less than full-time pursuit of qualifying
educational programs                   .

NGB FORM 5435-1-R (Supplemental)
1 Oct 1999
2. I understand MGIB-SR Kicker payments are not subject to Federal and State income tax
withholdings_________.
            (initials)
3. I understand that my unit commander or the commander's direct representative will initiate
procedures to document my eligibility for MGIB-SR, chapter 1606 benefits and Kicker
benefits___________.
          (initials)
4. I understand it is my responsibility to attain and retain a completed copy of a Notice of Basic
Eligibility (NOBE) from my state MGIB Manager_________.
                                                   (initials)
5. If I voluntarily or involuntarily transfer between units of the ARNG or USAR, including the
IRR, due to unit transition as described in AR 135-7, paragraph 1-14.1, or upon completion of my
six year Kicker obligation, and have not used the maximum 36 academic months of basic MGIB-SR
benefits, I will continue to receive Kicker benefits until basic MGIB-SR are exhausted_________.
                                                                                          (initials)

                                      SECTION VI - SUSPENSION
I understand that under certain conditions listed below I can be suspended on a one-time basis (per
soldier not contract) for a specified period from the Kicker program rather than being terminated.
Suspensions are limited to the following conditions:

     a. OCS Candidates only: If I fail to complete the OCS program benefits are suspended and I
must complete the six-year obligation __________.
                                      (initials)
     b. SMP Cadets who are voluntary or involuntarily separated from the SMP program and remain in
the ARNG, MGIB Kicker benefits are suspended __________.
                                                (initials)
c.   OCS and SMP participants who previously received a Kicker contract as an enlisted member and
fail to complete the OCS/SMP program must return to a Kicker eligible unit and complete the terms
of the original contract to retain Kicker eligibility _________.
                                                      (initials)

                                     SECTION VII - TERMINATION
My MGIB-SR Kicker incentive will be terminated should any of the following conditions occur before
the fulfillment of my enlistment agreement and obligation:
I agree to abide by all termination rules outlined in my original contract____________.
                                                                             (initials)

                         SECTION VIII - COMMISSIONING PROGRAM RESTRICTIONS

1. I understand by entering an Officer Commissioning Program (OCS or SMP) that my benefits are
increased to a rate of $             per month as a full time student as long as I complete the
commissioning program and accept a commission in the ARNG. (Only 36 months worth of MGIB-SR Kicker
benefits are authorized regardless of rate changes).

2. I understand that if I fail to complete the commissioning program that my MGIB-SR Kicker
benefits will return to the previous authorized rate of $             .

3. I understand that I may be eligible for an increased rate for MGIB-SR Kicker benefits only
twice if enrolled in a commissioning program.

4. I understand that I must fulfill my six-year obligation if I fail to complete a commissioning
program. If I do not complete my obligation by separating from the ARNG, I am subject to
recumbent_________.
          (initials)




NGB FORM 5435-1-R (Supplemental)
1 Oct 1999
                              SECTION IX- STATEMENT OF UNDERSTANDING

I have read and understand each of the statements above, in addition to my original contract, and
have had my questions satisfactorily answered. I understand the statements above are intended to
constitute all promises and agreements, whatsoever, concerning my enlistment for MGIB-SR Kicker
benefits.

    DATE SIGNED                                  APPLICANT'S SIGNATURE


        SSN                                  TYPED OR PRINTED NAME AND RANK



                        SECTION X - CERTIFICATION BY SERVICE REPRESENTATION

I certify that I have witnessed the reading and signing of the above agreement and the signature
appearing above is that of the applicant. I have verified the applicant meets the eligibility
requirements of AR 135-7, per HQDA annual policy guidance, for the MGIB-SR Kicker. No other
promises were made to the applicant as a condition of entitlement to the MGIB-SR Kicker under the
Selected Reserve Incentive Program. I have provided the applicant with a copy of this form.

    DATE SIGNED                            SINATURE OF SERVICE REPRESENTATIVE


       TITLE                                 TYPED OR PRINTED NAME AND RANK




                                                                       KICKER CONTROL #




NGB FORM 5435-1-R (Supplemental)
1 Oct 1999
                                                            Please read the instructions before completing this form.

                   Servicemembers’ Group Life Insurance Election and Certificate
Use this form to: (check all that apply)
q Name or update your beneficiary                                             Important: This form is for use by Active Duty and Reserve members. This form does
q Reduce the amount of your insurance coverage                                form does not apply to and cannot be used for any other Government Life
q Decline insurance coverage                                                  insurance.
Last name               First name                 Middle name                Rank, title or grade                           Social Security Number
,,
Branch of Service (Do not abbreviate)                         Current Duty Location


                                                              Amount of Insurance
By law, you are automatically insured for $400,000. If you want $400,000 of insurance , skip to Beneficiary(ies) and Payment Options. If you want
less than $400,000 of insurance, please check the appropriate block below and write the amount desired and your initials. Coverage is available in
increments of $50,000. If you do not want any insurance* , check the appropriate block below and write (in your own handwriting), “I do not want
insurance at this time.”
                                      Declining SGLI coverage also cancels all family coverage under the SGLI program.
                                q   I want coverage in the amount of $_______________________ Your initials________________
                                 q _______________________________________________________________________________
                                                           (Write “I do not want Insurance at this time.”)
*Note: Reduced or refused insurance can only be restored by completing form SGLV 8285 with proof of good health and compliance with other requirements. Reduced or refused insurance will
also affect the amount of Veterans' Group Life Insurance you can convert to upon separation from service.

                                                               Beneficiary(ies) and Payment Options
I designate the following beneficiary(ies) to receive payment of my insurance proceeds. I understand that the principal beneficiary(ies) will receive payment
upon my death. If all principal beneficiaries predecease me, the insurance will be paid to the contingent beneficiary(ies).
Complete Name (first, middle, last) and Address                      Social Security                                         Share to each beneficiary Payment Option                             (Lump
of each beneficiary                                                     Number                  Relationship to you                                                         sum or 36 equal monthly

                                                                        (if known)                                                  (Use %, $ amounts or                            payments)

Principal
1

2

3

4

Additional Principals on page 5 (check if applicable)
Contingent
1

2

3

4

Additional Contingents on page 5 (check if applicable)
I HAVE READ AND UNDERSTAND the instructions on pages 2 and 3 of this form. I ALSO UNDERSTAND that:
     This form cancels any prior beneficiary or payment instructions.
     The proceeds will be paid to beneficiaries as stated in #6 on page 3 of this form, unless otherwise stated above.
     If I have legal questions about this form, I may consult with a military attorney at no expense to me.
     I cannot have combined SGLI and VGLI coverages at the same time for more than $400,000.


SIGN HERE IN INK _______________________________________________ Date: ______________
                                        (Your signature. Do not print.)
                                                                 Do not write in space below. For official use only.
RECEIVED BY:                                   RANK, TITLE OR GRADE                           ORGANIZATION                                     DATE RECEIVED


SGLV 8286, September 2007                                                                                                                   Copy 1 = Member’s Official Personnel File   p. 2
                                                                                                                                              Copy 2 - To Member

                                                                                                                                              Copy 3 - To Active or Reserve Component of Uniformed Service
Standard Form 1199A (EG)                                                                                                                                              OMB No. 1510-0007
(Rev. June 1987)
Prescribed by Treasury
   Department                                         DIRECT DEPOSIT SIGN-UP FORM
Treasury Dept. Cir. 1076
                                                                                   DIRECTIONS
     To sign up for Direct Deposit, the payee is to read the back of this form                     The claim number and type of payment are printed on Government
     and fill in the information requested in Sections 1 and 2. Then take or                       checks. (See the sample check on the back of this form.) This
     mail this form to the financial institution. The financial institution will                   information is also stated on beneficiary/annuitant award letters and
     verify the information in Sections 1 and 2, and will complete Section 3.                      other documents from the Government agency.
     The completed form will be returned to the Government agency
     identified below.                                                                             Payees must keep the Government agency informed of any address
                                                                                                   changes in order to receive important information about benefits and to
     A separate form must be completed for each type of payment to be                              remain qualified for payments.
     sent by Direct Deposit.

                                                             SECTION 1 (TO BE COMPLETED BY PAYEE)
A    NAME OF PAYEE (last, first, middle initial)                                       D   TYPE OF DEPOSITOR ACCOUNT                           CHECKING            SAVINGS
,,                                                                                     E   DEPOSITOR ACCOUNT NUMBER
     ADDRESS (street, route, P.O. Box, APO/FPO)
0
     CITY                                     STATE          ZIP CODE                  F   TYPE OF PAYMENT (Check only one)
                                         ,                                                    Social Security                             Fed. Salary/Mil. Civilian Pay
     TELEPHONE NUMBER                                                                         Supplemental Security Income                Mil. Active
         AREA CODE                                                                 0          Railroad Retirement                         Mil. Retire.
 B   NAME OF PERSON(S) ENTITLED TO PAYMENT                                                    Civil Service Retirement (OPM)              Mil. Survivor
                                                                                              VA Compensation or Pension                  Other
                                                                                                                                                                  (specify)
 C   CLAIM OR PAYROLL ID NUMBER                                                        G           THIS BOX FOR ALLOTMENT OF PAYMENT ONLY (if applicable)
                                                                                       TYPE                              AMOUNT
     Prefix                                        Suffix
                PAYEE/JOINT PAYEE CERTIFICATION                                                       JOINT ACCOUNT HOLDERS’ CERTIFICATION (optional)
I certify that I am entitled to the payment identified above, and that I have                 I certify that I have read and understood the back of this form,
read and understood the back of this form. In signing this form, I                            including the SPECIAL NOTICE TO JOINT ACCOUNT HOLDERS.
authorize my payment to be sent to the financial institution named below
to be deposited to the designated account.
SIGNATURE                                                DATE                          SIGNATURE                                                          DATE


SIGNATURE                                                DATE                          SIGNATURE                                                          DATE


                                     SECTION 2 (TO BE COMPLETED BY PAYEE OR FINANCIAL INSTITUTION)
GOVERNMENT AGENCY NAME                                                                 GOVERNMENT AGENCY ADDRESS




                                              SECTION 3 (TO BE COMPLETED BY FINANCIAL INSTITUTION)
NAME AND ADDRESS OF FINANCIAL INSTITUTION                                                          ROUTING NUMBER                                                              CHECK
                                                                                                                                                                                DIGIT



                                                                                                   DEPOSITOR ACCOUNT TITLE



                                                                      FINANCIAL INSTITUTION CERTIFICATION

   I confirm the identity of the above-named payee(s) and the account number and title. As representative of the above-named financial institution, I
   certify that the financial institution agrees to receive and deposit the payment identified above in accordance with 31 CFR Parts 240, 209, and
   210,
PRINT OR TYPE REPRESENTATIVE’S NAME                    SIGNATURE OF REPRESENTATIVE                           TELEPHONE NUMBER            DATE



                                                  Financial institutions should refer to the GREEN BOOK for further instructions.
                           THE FINANCIAL INSTITUTION SHOULD MAIL THE COMPLETED FORM TO THE GOVERNMENT AGENCY IDENTIFIED ABOVE.
NSN 7540-01-058-0224                                                            GOVERNMENT AGENCY COPY                                                                        1199-207
                                                                                                                                          Designed using Perform Pro, WHS/DIOR, Mar 97
                                                                   OMB No. 1510-0007




TO BE COMPLETED BY PAYEE)




             THIS BOX FOR ALLOTMENT OF PAYMENT ONLY (if applicable)



              JOINT ACCOUNT HOLDERS’ CERTIFICATION (optional)




ETED BY PAYEE OR FINANCIAL INSTITUTION)




 MPLETED BY FINANCIAL INSTITUTION)
                                                                             CHECK
                                                                              DIGIT




L INSTITUTION CERTIFICATION




                                                                           1199-207
                                        Designed using Perform Pro, WHS/DIOR, Mar 97
Cadet's NAME   ,,
               (Last)                       (First)                          MI
Foreign-Language

Bi-Lingual Capability?

                             Fluent                   Conversational
Language                     (Read/Write)             (Read/Write-Limited)



Lived (Not Visited) in Foreign Country?               #Months




Studied Abroad? (Country)                             #Terms




High School Experience? (Language)                    #Terms




Completed Rosetta Stone Course?
Strategic or Non-Strategic                            Pass /Fail




College Level Language?
          Language                                    #Terms




Academic
Year:    Freshman            Sophomore      Junior    Senior
                                  Additional instruction information

Studied Abroad
1. For a study abroad lasting a semester, enter "3" in the # TERMS
2. For a study abroad lasting a quarter, enter "2" in the # TERMS
3. For a study abroad lasting two semesters, enter "6" in the # TERMS
4. For a study abroad lasting two quarters, enter "4" in the # TERMS
5. For a study abroad lasting three quarters, enter "6" in the # TERMS
6. For studies abroad where semester or quarter terminology is not used, simply enter
months of the study, but no more than "6" to equal an entire year.
7. In general, unless the Cadet has remained overseas in study continuously fro more than
a year, numbers greater than 6 will not be needed.

High School School Language Experience
1. For high school foreign language study lasting a semester, enter "3" in the # TERMS
2. For high school foreign language study lasting a quarter, enter "2" in the # TERMS
3. For high school foreign language study lasting two semesters, enter "6" in the # TERMS
4. For high school foreign language study lasting two quarters, enter "4" in the # TERMS
5. For high school foreign language study lasting three quarters, enter "6" in the # TERMS
6. For high school foreign language study lasting four semesters, enter "12" in the # TERMS
7. For high school foreign language study lasting six quarters, enter "12" in the # TERMS
8. For high school foreign language study lasting six semesters, enter "18" in the # TERMS
9. For high school foreign language study lasting nine quarters, enter "18" in the # TERMS
10. For high school foreign language study lasting eight semesters, enter "24" in the # TERMS
11. For high school foreign language study lasting twelve quarters, enter "24" in the # TERMS

Completed Rosetta Stone Course
"Pass" and "Fail", Note that only THREE strategic languages' courses may be entered, and an
additional THREE non-strategic languages' If the language is not listed, use the closest related
language, and enter the correct name.

College Level Language
1. For college foreign language study lasting a semester, enter "3" in the # TERMS
2. For college foreign language study lasting a quarter, enter "2" in the # TERMS
3. For college foreign language study lasting two semesters, enter "6" in the # TERMS
4. For college foreign language study lasting two quarters, enter "4" in the # TERMS
5. For college foreign language study lasting three quarters, enter "6" in the # TERMS
6. For college foreign language study lasting four semesters, enter "12" in the # TERMS
7. For college foreign language study lasting six quarters, enter "12" in the # TERMS
8. For college foreign language study lasting six semesters, enter "18" in the # TERMS
9. For college foreign language study lasting nine quarters, enter "18" in the # TERMS
10. For college foreign language study lasting eight semesters, enter "24" in the # TERMS
11. For college foreign language study lasting twelve quarters, enter "24" in the # TERMS
1. NAME        ,,


2. SSN                        0


3. BLOOD TYPE            0


4. RELIGIOUS PREF        0



                                  4a. RELIGIOUS CHOICES
          04   Assemblies of God                          44   Methodist
          06   Baptist American                           48   Muslim
          10   Baptist Other                              50   Nazarene
          08   Baptist Southern                           00   No Preference
          12   Brethren                                   53   Orthodox
          14   Buddhist                                   74   Other Religions(specify)
          16   Christian Science                          56   Pentecostal
          18   Church of Christ                           58   Presbyterian
          20   Church of God                              72   Protestant
          24   Disciples of Christ                        70   Protestant (Other)
          26   Episcopal                                  60   Reformed
          46   Evangelical Covenant                       62   Roman Catholic
          32   Friends (Quaker)                           64   Salvation Army
          34   Jehovah's Witnesses                        02   Seventh Day Adventist
          36   Jewish                                     66   Unitarian Universalist
          38   Latter Day Saints                          68   United Church of Christ
          40   Lutheran                                   99   Unknown
    Statement of Acknowledgement for Civilian Dental Records
                          (ROTC Cadet Cmd PAM 145-4, Para 2-55)


As per CC PAM 145-4, Para 2-55, all participants in the ROTC program who must use
government-owned or government contracted transportation are required to have dental films
for casualty identification purposes. The PMS is to ensure the cadets' dental records contain
sufficient documentation to aid in forensic identification.

         ROTC CADETS PLEASE COMPLETE THE FOLLOWING

________ I have verified with my dentist that my dental records do contain descriptive
profiles, bite wing x-rays, orthodontic profiles or dental x-rays for identification purposes.

________ I have verified with my dentist that my dental records do not contain descriptive
profiles, bite wing x-rays, orthodontic profiles or dental x-rays for identification purposes.


           My appointment is scheduled for             ________________,______________.
                                                                (Date)              (Time)




Dentist's Name:____________________________ Phone:__________________
Address: ____________________________________
          ____________________________________




DATE                                        CADET SIGNATURE

                                                           ,,
                                            Printed Name of Cadet

				
DOCUMENT INFO
Description: Writing a Cover Letter to a Prospect Employer document sample