det 630 cadet checklist below items must be ......det 630 cadet checklist below items must be...

DET 630 CADET CHECKLIST

Below items must be completed to be activated into AFROTC

Create WINGS Account (To officially apply/register for AFROTC, an account must be created)

- Instructions can be found at https://www.kent.edu/afrotc/future-cadets and by clicking on "AFROTC Guide to Applicant Admissions Process"

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DD FM 2983, Recruit Trainee Prohibited Activities or Acknowledgement DD FM 2005, Privacy Act Statement – Health Care RecordsDD FM 93, Record of Emergency DataMail Release Statement of UnderstandingDrug Demand Reduction Policy Statement of UnderstandingRelease of Student Records MFR

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Selective Service Registration “Males Only” - visit and click on "Verify"

The following items must be completed, signed, and uploaded as one document (.pdf) into the Secure Drop Box, prior to NCOP and/or attending AFROTC classes.

- Save your .pdf with the following naming convention - (ex. Smith, A. - Inprocessing Docs). - Upload the .pdf into the Secure Drop Box - https://goo.gl/forms/mhfrMYzoD24TxMG43

Provide a copy of your SAT or ACT Scores (your name must be on the copy)

AFROTC FM 28, Pre-Participatory Sports Physical. Must be completed/signed by your local physician at your own expense.HSSP or Academy Applicants - we will have your completed physical from DoDMERBPTG Worksheet

Original Birth Certificate (Required for verification purposes. A copy will be made and returned to you)

Original Social Security Card (we only need to verify it and will hand it back to you)

All above items must completed in the order listed to become an

active cadet in the Detachment. Failure to comply with these

standards will result in your removal from the program.

Academic Degree Plan (only Section I, Block 4 needs to be signed, however, the degree plan must be filled in)

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Completed AF FM 2030 - USAF Drug and Alcohol Abuse Certificate

In order to attend LLAB/PT and to be issued Physical Training Gear (PTG), the following items must be completed, signed, and uploaded as one document (.pdf) into the Secure Drop Box by 12 August 2019.

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- Save your .pdf with the following naming convention - (ex. Smith, A. - PMT Forms). - Upload the .pdf into the Secure Drop Box (link provided above)

The following documents must be provided at NCOP but no later than the first week of school

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o https://www.sss.gov/o

- ACT - http://www.actstudent.org/scores/ SAT- https://sat.collegeboard.org/scores

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https://na01.safelinks.protection.outlook.com/?url=https%3A%2F%2Fgoo.gl%2Fforms%2FmhfrMYzoD24TxMG43&data=01%7C01%7Clnelso19%40kent.edu%7C38490455a75f4cb95e0208d538e213d0%7Ce5a06f4a1ec44d018f73e7dd15f26134%7C1&sdata=GNj8yS9K7g%2BA0IRMR0HC8%2Fu6U9xVUOoMB2MVu5xf5%2BI%3D&reserved=0

http://www.actstudent.org/scores/

https://sat.collegeboard.org/scores

https://www.kent.edu/afrotc/future-cadets

PRIVACY ACT STATEMENT- HEALTH CARE RECORDS

This fo rm is not an authorization or consent to use or disclose your health information.

1. AUTHORITY FOR COLLECTION OF INFORMATION INCLUDING SOCIAL SECURITY NUMBER (SSN):

10 U.S. C. 136, Under Secretary of Defense for Personnel and Readiness; 10 U.S.C. Chapter 55, Medical and Dental Care;

42 U.S.C. Chapter 32, Third Pa1ty Liability for Hospital and Medical Care; 32 CFR Pa1t 199, Civilian Health and Medical

Program ofthe Uniformed Serv ices (CHAMPUS); DoD! 6055.05, Occupational and Environmenta l Hea lth (OEH); and

E.O. 9397 (SSN), as amended.

2 . PRINCIPAL PURPOSES FOR WHICH INFORMATION IS INTENDED TO BE USED:

Informatio n may be collected from you to provide and document your medical care; dete1mine your eligibi li ty for benefits

and entitlements; adjudicate claims; determine whether a third pa1ty is responsible for the cost of Military Health System

(MHS) provided healthcare and recover that cost; evaluate your fitness for duty and medical concerns which may have

resu lted from an occupational or environmental hazard; evaluate the MHS and its programs; and perform administrative tasks

related to MHS operations and personnel readiness.

3. ROUTINE USES:

Information in your records may be disclosed to:

• Private physicians and Federal agencies, includ ing the Department of Veterans Affairs, Health and Human Services, and

Homeland Security (with regard to members of the Coast Guard), in connection with your medical care;

• Government agencies to determine your e ligibi lity for benefits and entitlements; • Govemment and nongovernment th ird parties to recover the cost of MHS provided care; • Public health authorities to document and review occupational and environmental exposure data; and • Govemment and nongovernment organizations to perform DoD-approved research.

Information in your records may be used for other lawfu l reasons which may include teaching, compiling statistical data, and

eva luating the care rendered. Use and disclosure of your records outside of DoD may also occur in accordance with 5 U.S.C.

552a(b) of the Privacy Act of 1974, as amended, which incorporates the DoD Blanket Routine Uses published at:

http ://dpcld.defense.gov/privacv/SORNslndex/BlanketRoutineUses.aspx.

Any protected health information (PHl) in your records may be used and disclosed generally as permitted by the HIPAA

Privacy Rule (45 CFR Pa1ts 160 and 164), as implemented within DoD by DoD 6025.18-R. Permitted uses and disclosures of

PHl inc lude, but are not limited to, treatment, payment, and healthcare operations.

4. WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVIDING INFORMATION:

Voluntary. If you choose not to provide the requested information , comprehensive health care services may not be possible,

you may experience administrative delays, and you may be rejected for service or an assignment. However, care wi ll not be

denied.

This all inclusive Privacy Act Statement wi ll app ly to all requests fo r personal info rmation made by MHS health care treatment personnel or for medical/dental treatment purposes and is intended to become a permanent pa1t of your health care record.

Your signature merely acknowledges that you have been advised of the foregoing. fu rnished to you.

If requested, a copy ofthis form will be

-5. SIGNATURE OF: PA TIENL_OB..SPONS_QR

DO FORM 2005, JUN 2016

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6. SOCJAL..SECURITY NUMBER OR DOD IDENTIFICATION NUMBER OF MEMBER OR SPONSOR

PREVIOUS EDITION IS OBSOLETE.

- -7. DATE ('CC'r'YMMD_Q)

Adobe Des1gner 9.0

DEPARTMENT OF THE AIR FORCE

AIR UNIVERSITY (AETC)

MEMORANDUM OF UNDERSTANDING FOR DRUG TESTING POLICY FOR

CADETS PARTICIPATING IN RESERVE OFFICER TRAINING CORPS (ROTC)

By direction of the Secretary of the Air Force, I understand as an Air Force ROTC cadet

participating in a SROTC program, I will be subject to random urinalysis drug testing. I

understand that if I am randomly selected, I must provide the requested sample within the

specified time limits. I understand failure to report for a mandatory urinalysis test will be

considered an Unauthorized Absence (UA) and will result in individual command-directed

screening. I understand that any individual refusing to submit a urinalysis sample or testing

positive on a urinalysis test will be processed for disenrollment or dismissal from Air Force

ROTC or specific officer commissioning program.

__________________________________ __________________________________

Cadet Signature and Date Parent/Guardian Signature and Date

(Only for applicants under legal age of

majority. Must be notarized if not signed in

presence of detachment personnel)

_______________________________________________

Printed Name and Signature Witness (or Notary) and Date

lnelso19

Typewritten Text

NAME:_________________________________



The Detachment Commander (CC), the Personnel NCO (DP), and the Information Management

NCO (IM) need to open official US Air Force (USAF) correspondence delivered to the

detachment addressed to cadets. Access to these documents is for the verification and accuracy

of the contents ONLY. Specific documents we open are; assignment orders for cadets entering

active duty, cadet travel summaries, and cadet Leave and Earning Statements (LES). We must

verify these documents when received to ensure accuracy and to immediately correct or report

any discrepancies to higher headquarters. In accordance with the Privacy Act, we must have your

permission to access this mail. Therefore, request your sign your payroll signature below to

consent to our access. Giving consent is strictly voluntary. However, if you do not give your

consent, delays may be encountered in processing these vital items. Only OFFICIAL USAF

correspondence specifically approved by the detachment commander will be opened. Please sign

below if you agree to authorize cadre members to open OFFICIAL USAF mail addressed to you.

__________________________________ __________________________________

Cadet Signature and Date Parent/Guardian Signature and Date

(Only for applicants under legal age of

majority. Must be notarized if not signed in

presence of detachment personnel)

_______________________________________________

Printed Name and Signature Witness (or Notary) and Date

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Typewritten Text

NAME:________________________________

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Typewritten Text

Mail Release Statement of Understanding



DATE: _________________

CADET NAME ______________________________

1. In compliance with PL 93-389, “Family Educational Rights and Privacy Act”, your consent is

required to permit the educational institution or AFROTC Detachment in which you are/were

enrolled to release official copies of your transcripts of grades and/or other students records,

files, or data that are a part of your student records to Department of Defense (DoD) agencies, as

may be required by such agencies.

2. It is mutually understood that the purpose of this request for official copies of student records

is necessary for AFROTC screening and evaluation of this present and potential cadet members

and those cadets commissioned or disenrolled from the AFROTC program. It is further

understood that the privacy of the information collected by means of their request will be

maintained in accordance with the Privacy Act of 1974 and the Freedom of Information Act, and

the information will be used for official AFROTC evaluation.

3. Your signature below signifies receipt and agreement of the above statement and that you

have read and understand our request for official copes of your school records. And you hereby

voluntarily consent to the release of such official records as we may require in the above stated

request. You therefore authorize appropriate school officials or detachment personnel to release

the above requestor, their successor, or to the appropriate DOD agency any and all official

records, files, and date for their use as requested above.

_________________________________ _________________________________

(Students Signature)

(Parents Signature if student is under 18 years

of age)

lnelso19

Typewritten Text

Release of Student Records

Local Form (23 July 2019) ACADEMIC DEGREE PLAN Page 1 of 6

CADET'S SIGNATURE:

5. Initial Review (Cadre Use)

Completion of this Academic Degree Plan (ADP) should result in obtaining a (calendar month/year).

6. Institutional GPA / Degree Audit Review (prior to final semester)

1. Name (Last, First MI)SECTION I: ADMINISTRATIVE DATA

2. Academic Institution

3. Academic Major

DATE:

DATE:

PRIVACY ACT STATEMENT:The Privacy Act of 1974, as amended at 5 U.S.C. 552a, protects records that are retrieved by personal identifiers such as a name, social security number or other identifying number or symbol. An individualis entitled to access to his or her records and to request correction of these records if applicable. The Privacy Act prohibits disclosure of these records without written individual consent unless one of the twelve disclosure exceptions enumerated in the Act applies. These records are held in Privacy Act systems of records. A notice of any such system is published on this Privacy System Notices page. As with the Freedom of Information Act (FOIA), the Privacy Act binds only Federal agencies, and covers only records in the possession and control of Federal agencies. (http://www.privacy.af.mil/)

degree during

CADET'S SIGNATURE:

ACADEMIC ADVISOR SIGNATURE: DATE:

This is to certify additional classes have not been added to the course catalog. Student is scheduled to graduate in the programmed month/year stated in Block 4.

4. Cadet's Acknowledgement

AS-INSTRUCTOR SIGNATURE: DATE:

Any changes or alterations to Section I requires my Aerospace Instructor's approval and a new Academic Degree Plan to be submitted prior to making any changes with my instituion.

This is to certify an initial review of the cadet's ADP for has been conducted, and demonstrates the cadet's ability to commission with a Degree in FY

TERM: YEAR: TERM: YEAR:COURSE NUMBER

CREDIT HRS ATTEMPTED

CREDIT HRS COMPLETED DEVIATIONS COURSE

NUMBERCREDIT HRS ATTEMPTED

CREDIT HRS COMPLETED DEVIATIONS






CADET'S SIGNATURE / DATE:

AS-INSTRUCTOR SIGNATURE / DATE:


AS-INSTRUCTOR SIGNATURE / DATE:


AS-INSTRUCTORSIGNATURE / DATE:


AS-INSTRUCTOR'S SIGNATURE / DATE:

FILL OUT CREDIT HOURS ATTEMPTED AND COMPLETED FILL OUT CREDIT HOURS ATTEMPTED AND COMPLETED

COURSE TITLE COURSE TITLE

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PLANNED ACADEMIC PROGRAM Page _____ of _____

SECTION II: ACADEMIC DEGREE PLAN / TERM REVIEW

Academic Issues/Notes: (Cadre) Academic Issues/Notes: (Cadre)


AS-INSTRUCTOR RANK / NAME: AS-INSTRUCTOR RANK / NAME:













AFROTC REVIEWER'S SIGNATURE / DATE:


AFROTC REVIEWER'S SIGNATURE / DATE:














Attachment 3

ACADEMIC PLAN FOR FOREIGN LANGUAGE OR TECHNICAL REQUIREMENT FOR NON-TECHNICAL SCHOLARSHIP CADETS

Figure A3.1. Academic Plan. I understand that as a scholarship recipient I am required to take and pass a minimum of 4 semesters /6 quarters of the same foreign language or 24 semester/36 quarter hours of Math/Physics/Chemistry/Engineering. I understand that I must maintain at least a “C-” or the institutional equivalent in each course. I also understand that failure to accomplish this requirement prior to commissioning could result in loss of my scholarship and/or disenrollment from the AFROTC program. If disenrolled, I may have to repay my scholarship or be called to serve on active duty in my enlisted grade for a period of two years. In order to fulfill this requirement, I plan to take the following courses:

Course #

Course Title Hours Term

Schedule

Term Complete

Cadet Initial

Cadre Initial

Total:

Cadet Signature Date Cadre Signature Date

Typed/Printed Cadet Name Typed/Printed Cadre Name

I reviewed the completed course work for Cadet ______________________ and verify that he/she has completed a minimum of 4 semesters /6 quarters of the same foreign language or 24 semester/36 quarter hours of Math/Physics/Chemistry/Engineering, or will complete this requirement prior to commissioning (Except Nurses and 1-2-year scholarship winners). _________________________________ _________________________ AS Instructor Date

Non-technical major scholarship cadets, ONLY

Physical Training Gear (PTG) Worksheet

Name (Last, First, MI.):

(Circle One)

T-Shirt S M L XL

Shorts S M L XL

Warm-Up Jacket S M L XL

Warm-Up Pants S M L XL

NOTE: Please visit http://www.marlowwhite.com/measuring/size.html if you need

assistance with determining your correct size.

det 630 cadet checklist below items must be ......det 630 cadet checklist below items must be...

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