UC Berkeley Army ROTC Application Form
Please answer the following questions. The data collected will be used to predetermine your eligibility for enrollment in the ROTC program. Once your information has been reviewed, you will be contacted by the Recruiting Operations Team to schedule a telephonic or virtual interview. 
Your information is subject to the Privacy Act and will not be shared with anyone outside the UCB Army ROTC program.
Name *
First Name
Last Name *
Email *
Phone number *
Are you a US Citizen? *
Are you currently residing in the USA? *
Local Address (Street, City, State, Zip Code) *
Is this your permanent address? *
What city, state, and country were you born in? *
Date of birth *
MM
/
DD
/
YYYY
Academic Information
In order to be considered for enrollment in the Army ROTC program, all applicants must posses a high school diploma or equivalent, and must be a full-time student currently attending UC Berkeley or one of the affiliated crosstown 4-year universities listed below.  *Community college transfer students must have a minimum of 2 years remaining to complete the ROTC curriculum.
Do you have a high school diploma or equivalent? *
Are currently enrolled in a 4-year university? *
If yes, mark which school you are currently attending *
Required
If other, please list which school you are currently attending
Academic major/minor
What is your current academic class?
Clear selection
What is your projected graduation date? (MM/YYYY)
Are you considered an in-state or out-of-state student?
Clear selection
Current academic GPA
SAT/ACT Scores (if applicable)
Additional Information
Please provide as much possible information regarding any prior military service and medical/civil matters.  Details will be discussed once a determination has been made on your suitability for enrollment.  Answer all that apply.
Do you have any prior Military/ROTC/Officer training? *
If applicable, please describe your previous period(s) of service (include dates and discharge reason i.e. RE Code)
Are you currently serving in the military? *
If yes, which service?
Have you ever had any military disciplinary actions?
Clear selection
If yes, please briefly describe the nature and resolution of the disciplinary action
Do you have any law violations? *
Do you have any permanent injuries or medical illness that could hinder you from serving as an Army Officer? *
Answer the following questions in your own words
Why do you desire to become an Army Officer? *
What are your scholarly, athletic, and leadership achievements? *
How did you hear about our program? *
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