Army Rotc 4 - Year College Scholarship Applicant Checklist - Boise State University Page 2
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7BSU Army ROTC 4 - Year College Scholarship Application - High School Student
PART I - PERSONAL DATA
(Complete this block on every page of the application to ensure accurate processing)
1. SSN
2. First Name
MI
3. Last Name
Ext (Jr, Sr)
4. Street Address
5. City
6. State AL
7. Foreign Address Code
8. Zip Code
9. Educational Testing Scores
SAT- Verbal
SAT- Writing
ACT- Math
ACT- Nat Science
10. HS CGPA
SAT- Math
ACT- English
ACT- Reading
ACT- Writing
11. Birth Date
12. Sex
13. Height
14. Weight
(YYYY/MM/DD)
(M/F)
(inches)
(lbs)
15. Race -
Check all blocks that apply
American Indian or Alaska Native
Black or African American
Native Hawaiian or Other Pacific Islander
Asian
Hispanic or Latino
Other
White
Not Hispanic or Latino
16. Telephone Number
(commercial only)(DO NOT INCLUDE ANY DASHES OR SPECIAL CHARACTERS)
Overseas, start with country code; within U.S., start with area code
17. U.S. Citizenship
U.S. Citizen/National
Non U.S. Citizen
Pending Citizenship
18. Military Status
Served on Active Duty from which you were discharged or separated to civilian status. You must provide a copy of your DD Form 214.
Currently on full-time Active Military Service.
ETS Date is
Basic Active Service Date (BASD) is
Not Applicable
19. Marital Status
20. Dependency Status
Single
Married
Divorced
No Children
1-3 Children
More than 3 Children
21. Personal E-Mail Address
22. Have you ever been arrested, convicted or fined any violation of the Law?
If Yes, Please give a complete description of the incident (name and place of court, nature of offense, date,
No
Yes
disposition, and the amount of the fine imposed) in an electronic word document attached to this document.
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