Forms

Note that not all forms apply to all prospective Cadets.  The forms that apply to all Cadets interested in contracting with ROTC are preceded by an asterisk (*).  It is beneficial to have your forms and required documentation ready as soon as possible in order to prevent delays in processing scholarships, contracts, pay, and other incentives.  Students can download the forms or stop by Button Auditorium Room 306.  Feel free to contact Rhonda or Matt Chapman at (606)783-2050 for questions regarding forms and requirements.

Department of Defense Forms 

   DD Form 4-1 - Enlistment/Reenlistment Document for the Armed Forces of the United States 

*  DD Form 93 - Record of Emergency Data 

   DD Form 369 - Police Records Check 

 * DD Form 2005 - Privacy Act Statement - Health Care Records 

 * DD Form 2058 - State of Legal Residence Certificate 

 * DD Form 2351 - DoDMERB Report of Medical Examination  

    DD Form 2492 - DoDMERB Report of Medical History 

Department of the Army Forms 

DA Form 597, Army Senior Reserve Officer Training Corps (ROTC) Non-Scholarship Contract 

DA Form 597-1, Acknowledgement of Understanding, Non-Scholarship Two Year Program 

DA Form 597-3 - Army Senior Reserve Officer Corps (ROTC) Scholarship Contract 

DA Form 705 - Army Physical Fitness Test Scorecard 

DA Form 4824-R - Certificate and Acknowledgement of Service Requirements for Army Reserve SMP 

Cadet Command Forms 

Instructions for Completing CC Form 104-R 

* CC Form 104-R, Planned Academic Worksheet

CC Form 132-R, Statement of Understanding (Dependency)

* CC Form 136-R, Briefing on Government Sponsored Benefits for Cadets

* CC Form 137-R, Authorization/Declination for Access to Student Records

* CC Form 139-R, Cadet Enrollment Record

CC Form 167-R, Scholarship Acceptance/Declination Statement & PMS Validation

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 Change to GRFD or Dedicated ARNG Scholarship

CC Form 227-R, Request for Reserve Forces Duty Control Number

National Guard Buearu Forms 

 NGB Form 594-1 - Annex to DD Form 4/DA Form 4836 - ARNG Simultaneous Membership Program (SMP) Agreement

NGB 5435-1-R - Supplemental to DD Form 4 - Statement of Understanding

Miscellaneous Forms 

SGLV 8296 - Serviceman's Group Life Insurance Election and Certificate 

SF 86 - Electronic Personnel Security Questionnaire Worksheet 

*  SF 1199A - Direct Deposit Sign Up Form (with "Voided" check attached)

*  W-4 - Employee's Withholding Allowance Certificate 

Required Documentation 

* Birth Certificate (or Naturalization Certificate, if applicable)

* Proof of Citizenship (Social Security Card)

* Current Shot Record

* Official Transcripts (from all high schools and/or colleges attended)

   DD-214 (if prior service)