us army rotc green to gold 4, 3, and 2-year scholarship application

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U.S. ARMY ROTC GREEN TO GOLD 4, 3, AND 2-YEAR SCHOLARSHIP APPLICATION
(Cadet Command Reg 145-1)
STATEMENT REQUIRED BY PRIVACY ACT OF 1974
1. AUTHORITY: 10 USA 2102 AND 2107 2. PRINCIPAL PURPOSE(S): Form is used to make application for a Green to Gold 4, 3, or 2-year scholarship 3. ROUTINE USES: Form is used to obtain selection and eligibility information applicants for 4,3, or 2-year scholarships. 4.
MANDATORY OR VOLUNTARY DISCLOSURE AND EFFECT ON INDIVIDUAL NOT PROVIDING INFORMATION: Information provided on this form is mandatory, without the data provided on this form, the application cannot be considered for a scholarship.
1. SSN 2. NAME OF APPLICANT 3. DATE OF BIRTH
4. SEX:
(LAST NAME (SPACE), FIRST NAME (SPACE), MIDDLE INITIAL
Y Y M M D D
5. RACE/ETHNIC:
6. HOME ADDRESS
STREET CITY ST ZIP CODE
7. WORK ADDRESS
STREET (Unit of Assignment) CITY
ST
ZIP CODE
8. TELEPHONE NUMBER
(Include Area Code/Include Country Codes for overseas)
9. MARITAL
STATUS
10. NO OF
DEPENDENTS
11. SPOUSE MILITARY
CITIZENSHIP
12. SOURCE OF
NUMBER
NATURALIZATION
13. RANK
HOME
WORK
14. DATE OF ENLISTMENT ENLISTED EXPIRATION DATE
15. MOS 16. GENERAL TECHNICAL 17. APFT
2-MILE RUN APFT APFT
Y Y M M D D Y Y M M D D APTITUDE AREA SCORE PUSH UPS SIT UPS MIN SEC
SUM PASS
INDICATE PERIOD OF ORIGINAL ENLISTMENT
Y Y M M D D IF DATE SPECIFIED IS A REENLISTMENT DATE,
CONVICTIONS 18. CIVIL
CLEARANCE COMPLETED
19. FAVORABLE SECURITY
WHAT TYPE
20. NAME OF COLLEGE OR UNIVERSITY YOU WILL BE ATTENDING
21. SCHOOL CODE
ROTC USE ONLY
24. RESIDENT
STUDENT STATUS
25. ACADEMIC
MAJOR CODE
22. IF ITEM 19 DOES NOT HOST ARMY ROTC
INDICATE SCHOOL AT WHICH YOU WILL TAKE ROTC
23. SCHOOL CODE
ROTC USE ONLY
26. SCHOLARSHIP TYPE (Masters=M; 2-Yr = 2; 3-Yr = 3 4-Yr = 4)
27. LIST AWARDS, DECORATIONS OR SPECIAL RECOGNITION BESTOWED UPON APPLICANT WHILE ON ACTIVE DUTY
28. E-Mail Address of Applicant 29. FAX Number for Applicant
30. SIGNATURE OF APPLICANT AND DATE 31. VERIFICATION AND SIGNATURE BY THE MILPO OFFICE (INCLUDE RANK) DATE
ROTC CADET COMMAND FORM 173-R, AUG 01 REPLACES ROTC CADET COMMAND FORM 173-R, DTD SEP 94, CURRENT SUPPLIES CAN BE USED

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U.S. ARMY ROTC GREEN TO GOLD 4, 3, AND 2-YEAR SCHOLARSHIP APPLICATION
32. STATE BRIEFLY WHY YOU DESIRE TO RECEIVE A COMMISSION AS AN ARMY OFFICER AND PURSUE A MILITARY CAREER
33. COMMANDING OFFICER'S EVALUATION
a. STATEMENT AS TO THE APPLICANT'S MILITARY APTITUDE AND MOTIVATION
b. STATEMENT AS TO THE APPLICANT'S PERFORMANCE ON ACTIVE DUTY AND POTENTIAL TO BE ELIGIBLE AND QUALIFIED TO RECEIVED A REGULAR ARMY COMMISSION, IF OFFERED.
COMMANDING OFFICER'S RECOMMENDATION FOR SCHOLARSHIPS HIGHLY RECOMMEND RECOMMEND DO NOT RECOMMEND
SIGNATURE OF COMMANDING OFFICER TYPED NAME OF COMMANDING OFFICER & TELEPHONE NUMBER: DATE:
34. FIELD GRADE COMMANDER'S EVALUATION AND RECOMMENDATION FOR A SCHOLARSHIP
SIGNATURE OF FIELD GRADE OFFICER TYPED NAME OF FIELD GRADE OFFICER & TELEPHONE NUMBER: DATE:
ROTC CADET COMMAND FORM 173-R, AUG 01 REPLACES ROTC CADET COMMAND FORM 173-R, DTD SEP 94, CURRENT SUPPLIES CAN BE USED
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