Form Nstc 1533/133 - College Program Application

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NAVAL RESERVE OFFICERS TRAINING CORPS
COLLEGE PROGRAM APPLICATION
Privacy Act Statement
Authority: The authority to request this information is contained in: 5 USC § 301 (Authorizing Forms and Regulations); Executive Order 9397 (Use of
Social Security Numbers).
Principal Purpose(s): To be completed by applicants for the Naval Reserve Officers Training Corps (NROTC) College Program.
Routine Use(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: You are not required to provide this information; however, failure to do so will result in an inability to fairly evaluate your application and
may result in an inability to process the application.
Personal Information
Name
SSN (last 4)
Date of Birth
Phone Number
Cell Phone Number
Place of Birth
Current Mailing Address
Name of Parent/Guardian
Address of Parent/Guardian
USN
USMC
Are you a US Citizen?
Yes
No
If Naturalized, give date, place, court of jurisdiction, and certificate number:
Military Experience and Training (Past and Present, if any)
Service
Dates of Service
Highest Rank
EAOS
Type of Discharge
Training Programs
Position(s) Held
Awards
Grades of Participation
JROTC
9
10
11
12
(Service _________)
Civil Air Patrol
9
10
11
12
Other (NDCC, etc.)
9
10
11
12
Extracurricular Activities
READ CAREFULLY: Identify only those activities in which you engaged during school grades 9-12. NROTC is particularly interested in identifying
activities in which an applicant has participated involving responsibility and leadership.
Organization
Position(s) Held
Hrs/ Wk
Grades of Participation
9
10
11
12
9
10
11
12
9
10
11
12
9
10
11
12
Athletic Activities
READ CAREFULLY: Identify only those sports which you participated in during school grades 9-12. Mark the year in which you received a letter and/or
you were on varsity. Mark the box if you participated in JV or on a club team during any year. Do not list intramural activity.
Sport
Letter
Varsity
JV/Club
Position(s) Held
Awards/Recognition
9
10
11
12
9
10
11
12
9
10
11
12
9
10
11
12
9
10
11
12
9
10
11
12
Other Activities
Attach additional sheets, if needed, to identify other activities not listed above that involve considerable responsibility and leadership. List positions
held and the average number of hours devoted per week to the activity.
NSTC 1533/133 (10-11)
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