ECP National Winners General Information Form

Awardee Information
Last Name*
First Name*
Street Address*
City*
State*
Zip Code*
Cell Phone*
Home Phone
Email Address*
Date of Birth*
Social Security Number*
Place of Birth*
US Citizen*
- Yes
- No

Save and Continue Later

Mini-Camp
If 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
Acknowledgement
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.*
- I certify
Printed Signature*
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

Save and Continue Later

Awardee Information

Academic Information

JROTC Participation

History

Medical

Tattoo Information

Mini-Camp

Acknowledgement

Transcript and Test Score Upload

National Board ECP Awardee Form

Step 1 of 6

Awardee Information

Academic Information

JROTC Participation

History

Medical

Tattoo Information

Mini-Camp

Acknowledgement

Transcript and Test Score Upload