ROTC Contact Form

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:

Weight:

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:

Have you ever been arrested, convicted, 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:

image description Fall Semester
Early Action 11/15-12/15
Regular Action 2/20-4/1

Spring Semester
Regular Action Only11/15-12/

1005 State University Drive • Fort Valley, GA 31030 • 478-825-6211

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