ROTC Contact Form

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Please fill out the form below and someone from ROTC will contact you shortly.

Name: *

Contact Information

Street: *

City: *

State: *

Zip: *

Home Phone:

Cell Phone:

E-mail address: *

Personal Information

Height: (ex. 5 ft. 10 in.)

Weight: lb.

Birthday:

Sex:

Female

Male

Marital Status:

Married

Single

Education Information

Name of Current High School or College:

City:

State:

Zip:

Current GPA:

Intended College Major/Current Major:

College Prep:

Classification:

Extracurricular Activities :

Describe your current physical fitness level:

Note any limitations, medical conditions, i.e. allergies or asthma, hearing or sight problems, etc.

Have you ever been arrested, convited, or fined for any violation of the law?:

Yes

If yes, please explain in detail and include final disposition:

Describe your educational and military goals (if applicable) and objectives.:

Fort Valley State University