〉 Go To the Academy Site Alumni Overview Alumni Awards Alumni Ambassador Alumni Regiments Alumni Officers and Directors Early Commissioning/ROTC ECP APPLICATION ROTC Overview Application Process Scholarships National Board ECP Awardees ECP FAQ VFMC Army ROTC Staff Please complete all the required fields below. Step 1 of 12 8% Name* First Last Cell Phone*Email* Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Home PhoneDate of Birth*Social Security Number*Place of Birth*U.S. Citizen*YesNo Academic InfoHigh School Attended*High School Address*High School Phone Number*High School Graduation Date*High School Guidance Counselor's NameJROTC Participation* Yes No How many years in JROTC?*Senior Army Instructor's Name* First Last Have you applied for a three-year or four-year ROTC Scholarship?* Yes No Prior ServicePrior Service* No Yes Active Reserves National Guard If discharged, enter Reenlistment CodeUnit NameUnit PhoneUnit AddressPlease select the appropriate form: DD Form 4 (Guard and Reserve Only) DA Form 220 DD Form 214 Please upload appropriate copy of above form: MeasurementsHeight (inches)*Weight (pounds)*Hat Size*Shoe Size*T-Shirt Size*Prior ConvictionsDo you now or have you had any civil or criminal convictions?* Yes No 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 without statement.)* I agree Medical InformationHave you taken a DODMERB Physical?* Yes No Do you have a history of asthma?* Yes No When was the last time you had an asthma attack?Do you use asthma medication? Yes No Have you ever taken the Methacholine Challenge Test (MCT)? Yes No Have you ever been treated by a medical professional for psychological disorders (i.e. Depression, ADHD)?* Yes No Were any medications prescribed?* Yes No Are you currently taking medication?* Yes No How long have you been taking medication?*Do you have any academic accommodations at your school?* Yes No Do you have any allergies? (i.e. seasonal, food, bee sting)* Yes No Please specify allergies*Have you ever undergone immunotherapy?* Yes No Please list all current medications.*Do you currently have, or have you ever had joint injuries? (i.e. knee pain, hip or shoulder dislocation)* Yes No Please explain when and what joint injuries you have had? (i.e. knee pain, hip or shoulder dislocation)*Have you ever worn a support brace? (i.e. metal or cloth, this is not a neoprene type support band)* Yes No Do you currently wear a support brace?* Yes No For what injury do you wear a support brace?*How long did / have you worn the brace?*Have you ever been treated for any ocular disorders (disorders of the eye)?* Yes No Have you undergone Lasik Surgery?* Yes No When was the surgery or treatment?*Have you ever undergone a surgical procedure?* Yes No When was the surgical procedure(s)?*What condition was the surgical procedure(s) for?*Are there any medical conditions, not mentioned in this document, which you have been diagnosed with? (Please explain)*By signing this form, I acknowledge that I have disclosed any and all pre-screening medical conditions that would make me ineligible for enrollment in the ECP ROTC Program as specified in statute, and Army regulation (AR 145-1). Failure to disclose or to have disclosed my disqualifying conditions, including any conditions I should have known about, will subject me to disenrollment from the ROTC Program.* I agreePrinted Signature* Tattoo InformationDo you have any tattoos?* Yes No Do you have any tattoos on or above the neck (above the t-shirt line)?* Yes No Do you have any tattoos on or below the wrist?* Yes No Do you have any tattoos on or below the elbow?* Yes No Do you have any tattoos below the knee?* Yes No Do you have tattoos anywhere else on your body?* Yes No Please explain where your tattoos are located:*How may tattoos do you have total?*Tattoo Size (in inches). If you have more than one, please number them: example: (1) 3 inches (2) 2.5 inches*Description of tattoo (what does it represent). If you have more than one, please number them; example: (1) Mothers name (2) Flower represents peace.*Printed Signature* Leadership TrainingIf you have not attended Basic Training and AIT, you will be completing ROTC Basic Camp at Fort Knox, Kentucky. In order to better prepare our incoming cadets, we provide a four day Leaders Training Course (referred to as “mini camp”) on campus at Valley Forge Military College. We will contact you in the spring to coordinate travel arrangements. The Army pays for your travel to and from Army training to either the school, or your home of record. Note: the Army does not coordinate or pay for travel to report to school or during school holidays and breaks unless you are attending Army training during that time.* I understand I have attended:* Army Basic Training Army Basic Training and AIT Neither AcknowledgementI 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.* I certify 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.* I acknowledge Printed Signature* ROTC Scholarship Applicant SnapshotData required by the Privacy Act of 1974 1. Authority: 10 USC 2101 and 2107 2. Principal Purpose(s) To physically identify each applicant 3. Routine Uses: To be used by the ROTC selection board in consideration of the applicant. 4. Mandatory or voluntary disclosure and effect on the individual for not providing the information: Use of this form is mandatory, applicant may not be considered if picture is not submitted.* I acknowledge Attach recent snapshot (within last 3 months) Full length preferred, at least knees upPrinted Signature of Applicant*SSN*Current Height*Current Weight*Month and Year of Photo* Extracurricular/Athletic/ Leadership Activities RecordName (Last, First, Middle)*SSN*Instructions Indicate below your participation in extracurricular, athletic and leadership activities. Any recognized activity not listed should be in “other.” Be certain to indicate all leadership positions held. If additional space is needed, use the space provided in section E.* I understand Athletic ActivitiesSports*NoneBaseball / SoftballBasketballBoxingFootballGolfGymnasticsHockeySoccerSwimmingTrackTennisWrestlingRifle TeamOther (Please explain below)Was the applicant a member, letter, captain or all district? Please explain what grades and participation levelSports*NoneBaseball / SoftballBasketballBoxingFootballGolfGymnasticsHockeySoccerSwimmingTrackTennisWrestlingRifle TeamOther (Please explain below)Was the applicant a member, letter, captain or all district? Please explain what grades and participation levelSports*NoneBaseball / SoftballBasketballBoxingFootballGolfGymnasticsHockeySoccerSwimmingTrackTennisWrestlingRifle TeamOther (Please explain below)Was the applicant a member, letter, captain or all district? Please explain what grades and participation levelOther:Was the applicant a member, letter, captain or all district? Please explain what grades and participation level Extracurricular ActivitiesActivities*NoneChurch GroupDebateDramaticsScholastic SocietiesSchool BandSchool NewspaperStudent NewspaperStudent GovernmentYearbookDrill TeamAgricultureSocial FraternitiesJunior ROTCOther (Please explain below)Years in each activity?Activities*NoneChurch GroupDebateDramaticsScholastic SocietiesSchool BandSchool NewspaperStudent NewspaperStudent GovernmentYearbookDrill TeamAgricultureSocial FraternitiesJunior ROTCOther (Please explain below)Years in each activity?Activities*NoneChurch GroupDebateDramaticsScholastic SocietiesSchool BandSchool NewspaperStudent NewspaperStudent GovernmentYearbookDrill TeamAgricultureSocial FraternitiesJunior ROTCOther (Please explain below)Years in each activity?Other:Success achieved for each activity (awards, position of leadership, etc.)Use this space to list any and all other activities/involvement to include employment. For work experience, please include the number of hours each week.Printed Signature* Applicants Personal StatementFull Name*SSN*State below in your own words why you desire to receive a commission as an Army Officer.*Printed Signature* Transcript and Test Score UploadPlease upload your High School Transcript*Accepted file types: jpg, gif, png, pdf.Please upload your SAT and/or ACT scores*Accepted file types: jpg, gif, png, pdf.
