Form Nstc 1533/126 - Application For Assignment To Housing

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NAVAL RESERVE OFFICERS TRAINING CORPS

ACCEPTANCE AND OATH OFFICE

Privacy Act Statement

Authority: The authority to request this information is contained in: 5 USC § 301 (Authorizing Forms and Regulations) and 10 USC Sec. 2104, Subtitle

A, Part III, Chapter 103 (Senior ROTC).

Principal Purpose(s): Used when administering the acceptance and oath of office for new Naval Reserve Officers Training Corps (NROTC)

Midshipman.

Routine Purpose(s): Information you provide in this application is protected by the Privacy Act and will not be released outside the Department of

Defense without your permission unless it comes within an exception to the Act or one of the routine uses in 32 CFR § 701.112,

and the routine uses set forth here.

Disclosure: Failure to provide the requested information may result in removal from the NROTC program and/or loss of scholarship benefits.

ACCEPTANCE

I,___________________________________________________________________________________,having been permanently appointed as

Midshipman, (USNR/USMCR) from the ___________________________________ day of _______________________, ____________________ do

accept such appointment.

__________________________________________________

APPOINTEE SIGNATURE

OATH OF OFFICE

I,___________________________________________________________________________________,having been appointed a midshipman, do

solemnly swear (or affirm) that I will support and defend the Constitution of the United States against all enemies, foreign and domestic; that I will bear

true faith and allegiance to the same; that I take this obligation freely, without any mental reservation or purpose of evasion; and that I will well and

faithfully discharge the duties of office on which I am about to enter: So help me God.

__________________________________________________

APPOINTEE SIGNATURE

Subscribed and sworn to before me this __________ day of ___________, ___________.

__________________________________________________

WITNESSING OFFICER PRINTED NAME

__________________________________________________

WITNESSING OFFICER SIGNATURE

NSTC 1533/126 (07-11)