Vfmc Army Rotc Program Application Form Page 2
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8VFMC Army ROTC Program Application for ECP, page 2
Personal Data:
Height: _______ Weight: _______ Hat Size: _____ Shoe Size: _____ T-Shirt Size: _____
Do you now or have you had any civil or criminal convictions? Yes
___ No ___
*
* If you checked “Yes” above, submit a statement of facts on a separate sheet of paper that includes
circumstances, dates, actions, charges, results and satisfaction of sentence. Traffic tickets in excess
of six per year or one totaling $250 or more requires a statement and/or waiver.
(Note: Application will not be processed witout statement.)
Have you applied for a three-year or four-year ROTC Scholarship? Yes ___ No ___
Have you taken a DODMERB Physical? Yes ___ No ___
____ Attending the ROTC Leaders Training Course
You will be:
(must check one)
____ Enlisting in the Guard/Reserve for Basic Training
Note: In order to better prepare high school graduates for ROTC , we conduct
a Leaders Training Course at VFMC for four days prior to the cadets’ departure
for Fort Knox, KY. Please provide the following information if you would like
to attend so that we may make travel arrangements. The Army covers travel
expenses to and from the Leaders Training Course .
My travel plans to VFMC to attend Leaders Training Course are as follows:
Automobile (if within 90 minutes): ____ Army-paid flight: ____
Airport I prefer to leave from and return to is: ______________________
I certify that all information provided within this document is true and correct to the best of
my knowledge. I submit this application subject to the penalties of Pennsylvania Criminal
Code, Title 18, Section 4904, relating to unsworn falsification to authorities. I understand
that if I have withheld or given false information, I may be denied admission or dismissed
from the Army ROTC program at Valley Forge Military College.
Signature: ___________________________________________ Date: _______________
DATA REQUIRED BY THE PRIVACY ACT OF 1974:
1.
Authority: Title 10 USC 3012 (Section 2101 and 2111)
2.
Principle Purpose: To obtain information to determine eligibility for participation in the Army ROTC
Program; to provide information necessary for processing Basic Camp and advanced ROTC applications.
3.
Routine Uses: To provide information on address and telephone numbers to facilitate contact with the
candidate and his/her family; to make matter of record the physical characteristics of the candidate; to
provide information essential for a fair evaluation of the candidate’s acceptability for Basic Camp attendance
or advanced ROTC participation.
4.
Mandatory or Voluntary Disclosure and Effect on Individual: Disclosure of Social Security Number is
mandatory and required for identification. Failure to provide Social Security Number will preclude
processing of the candidate’s application. Disclosure of all other information is voluntary; however, failure
to provide all of the voluntary information may delay or prevent processing of applications for Basic Camp
or entry into the ROTC advanced course.
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