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Page 1: PRINT NAMEPRINT NAME & DATESIGNATURE...LEAVE BLANK MARK APPLICATION BOX CURRENT DATE, PRINTED NAME, & SIGNATURE PRINT NAME TYPE DET 004 NOTE: HIGH SCHOOL SCHOLARSHIP WINNERS ARE NOT
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PRINT NAME
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PRINT NAME & DATE
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SIGNATURE
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Page 2: PRINT NAMEPRINT NAME & DATESIGNATURE...LEAVE BLANK MARK APPLICATION BOX CURRENT DATE, PRINTED NAME, & SIGNATURE PRINT NAME TYPE DET 004 NOTE: HIGH SCHOOL SCHOLARSHIP WINNERS ARE NOT
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PRINT NAME, INITIAL, CURRENT DATE
Page 3: PRINT NAMEPRINT NAME & DATESIGNATURE...LEAVE BLANK MARK APPLICATION BOX CURRENT DATE, PRINTED NAME, & SIGNATURE PRINT NAME TYPE DET 004 NOTE: HIGH SCHOOL SCHOLARSHIP WINNERS ARE NOT
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Page 4: PRINT NAMEPRINT NAME & DATESIGNATURE...LEAVE BLANK MARK APPLICATION BOX CURRENT DATE, PRINTED NAME, & SIGNATURE PRINT NAME TYPE DET 004 NOTE: HIGH SCHOOL SCHOLARSHIP WINNERS ARE NOT
Mark Christmas
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Do not sign unless you are a US citizen
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Please mark only one of the "swear" or "affirm" boxes
Page 5: PRINT NAMEPRINT NAME & DATESIGNATURE...LEAVE BLANK MARK APPLICATION BOX CURRENT DATE, PRINTED NAME, & SIGNATURE PRINT NAME TYPE DET 004 NOTE: HIGH SCHOOL SCHOLARSHIP WINNERS ARE NOT
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Enter today's date, Printed Name, and Signature
Page 6: PRINT NAMEPRINT NAME & DATESIGNATURE...LEAVE BLANK MARK APPLICATION BOX CURRENT DATE, PRINTED NAME, & SIGNATURE PRINT NAME TYPE DET 004 NOTE: HIGH SCHOOL SCHOLARSHIP WINNERS ARE NOT
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VERY IMPORTANT INFO: READ IN ITS ENTIRETY
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SIGN AND PUT CURRENT DATE
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IF YOU HAVE NO CIVIL INVOLVEMENTS, FILL OUT AS "NONE". IF YOU HAVE ANY CIVIL INVOLVEMENTS, USE THE NEXT PAGE AS AN EXAMPLE
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DO NOT FILL IN THIS AREA
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DO NOT FILL IN THIS AREA
Mark Christmas
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DO NOT FILL IN THIS AREA
Page 7: PRINT NAMEPRINT NAME & DATESIGNATURE...LEAVE BLANK MARK APPLICATION BOX CURRENT DATE, PRINTED NAME, & SIGNATURE PRINT NAME TYPE DET 004 NOTE: HIGH SCHOOL SCHOLARSHIP WINNERS ARE NOT
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VERY IMPORTANT INFO: READ IN ITS ENTIRETY
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FILL OUT ANY CIVIL INVOLVEMENT(S) YOU HAVE TO DATE. INCLUDE TYPE AND DATE OF INVOLVEMENT, ARRESTING AUTHORITY, AND DISPOSITION (IF DISPOSITION IS PENDING, ANNOTATE AS SUCH)
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DO NOT FILL IN THIS AREA
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DO NOT FILL IN THIS AREA
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SIGN AND PUT CURRENT DATE
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DO NOT FILL IN THIS AREA
Page 8: PRINT NAMEPRINT NAME & DATESIGNATURE...LEAVE BLANK MARK APPLICATION BOX CURRENT DATE, PRINTED NAME, & SIGNATURE PRINT NAME TYPE DET 004 NOTE: HIGH SCHOOL SCHOLARSHIP WINNERS ARE NOT
Mark Christmas
Rectangle
Page 9: PRINT NAMEPRINT NAME & DATESIGNATURE...LEAVE BLANK MARK APPLICATION BOX CURRENT DATE, PRINTED NAME, & SIGNATURE PRINT NAME TYPE DET 004 NOTE: HIGH SCHOOL SCHOLARSHIP WINNERS ARE NOT
Mark Christmas
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LEAVE BLANK
Page 10: PRINT NAMEPRINT NAME & DATESIGNATURE...LEAVE BLANK MARK APPLICATION BOX CURRENT DATE, PRINTED NAME, & SIGNATURE PRINT NAME TYPE DET 004 NOTE: HIGH SCHOOL SCHOLARSHIP WINNERS ARE NOT
Page 11: PRINT NAMEPRINT NAME & DATESIGNATURE...LEAVE BLANK MARK APPLICATION BOX CURRENT DATE, PRINTED NAME, & SIGNATURE PRINT NAME TYPE DET 004 NOTE: HIGH SCHOOL SCHOLARSHIP WINNERS ARE NOT
Page 12: PRINT NAMEPRINT NAME & DATESIGNATURE...LEAVE BLANK MARK APPLICATION BOX CURRENT DATE, PRINTED NAME, & SIGNATURE PRINT NAME TYPE DET 004 NOTE: HIGH SCHOOL SCHOLARSHIP WINNERS ARE NOT
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INITIALS ONLY
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IF NO DEPENDENTS THEN INITIAL ONLY. IF YOU DO HAVE DEPENDENTS THEN FOLLOW DIRECTIONS ON THE NEXT PAGE
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CURRENT DATE, PRINTED NAME, SSAN, & SIGNATURE
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MARK BOX FOR CURRENT MARITAL STATUS
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LEAVE BLANK
Page 13: PRINT NAMEPRINT NAME & DATESIGNATURE...LEAVE BLANK MARK APPLICATION BOX CURRENT DATE, PRINTED NAME, & SIGNATURE PRINT NAME TYPE DET 004 NOTE: HIGH SCHOOL SCHOLARSHIP WINNERS ARE NOT
Page 14: PRINT NAMEPRINT NAME & DATESIGNATURE...LEAVE BLANK MARK APPLICATION BOX CURRENT DATE, PRINTED NAME, & SIGNATURE PRINT NAME TYPE DET 004 NOTE: HIGH SCHOOL SCHOLARSHIP WINNERS ARE NOT
Mark Christmas
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MARK APPLICATION BOX
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CURRENT DATE, PRINTED NAME, & SIGNATURE
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Page 15: PRINT NAMEPRINT NAME & DATESIGNATURE...LEAVE BLANK MARK APPLICATION BOX CURRENT DATE, PRINTED NAME, & SIGNATURE PRINT NAME TYPE DET 004 NOTE: HIGH SCHOOL SCHOLARSHIP WINNERS ARE NOT
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PRINT NAME
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TYPE DET 004
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NOTE: HIGH SCHOOL SCHOLARSHIP WINNERS ARE NOT REQUIRED TO FILL OUT THIS FORM. FOR ALL OTHERS YOU ARE REQUIRED TO FILL OUT THIS FORM. THIS FORM WILL NEED TO BE COMPLETED & SIGNED BY A PHYSICIAN PRIOR TO PARTICIPATING IN ANY PHYSICAL FITNESS ACTIVITIES.
Page 16: PRINT NAMEPRINT NAME & DATESIGNATURE...LEAVE BLANK MARK APPLICATION BOX CURRENT DATE, PRINTED NAME, & SIGNATURE PRINT NAME TYPE DET 004 NOTE: HIGH SCHOOL SCHOLARSHIP WINNERS ARE NOT
Page 17: PRINT NAMEPRINT NAME & DATESIGNATURE...LEAVE BLANK MARK APPLICATION BOX CURRENT DATE, PRINTED NAME, & SIGNATURE PRINT NAME TYPE DET 004 NOTE: HIGH SCHOOL SCHOLARSHIP WINNERS ARE NOT
Mark Christmas
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CIRCLE "YES" OR "NO"
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PRINTED NAME & SIGNATURE
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Page 18: PRINT NAMEPRINT NAME & DATESIGNATURE...LEAVE BLANK MARK APPLICATION BOX CURRENT DATE, PRINTED NAME, & SIGNATURE PRINT NAME TYPE DET 004 NOTE: HIGH SCHOOL SCHOLARSHIP WINNERS ARE NOT
Mark Christmas
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Mark Christmas
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SIGNATURE, SSAN, & CURRENT DATE
Page 19: PRINT NAMEPRINT NAME & DATESIGNATURE...LEAVE BLANK MARK APPLICATION BOX CURRENT DATE, PRINTED NAME, & SIGNATURE PRINT NAME TYPE DET 004 NOTE: HIGH SCHOOL SCHOLARSHIP WINNERS ARE NOT
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PLEASE ENSURE YOU UNDERSTAND ALL DEFINITION BEFORE FILLING OUT FORM
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INITIALS ONLY; ANSWER EACH BOX TRUTHFULLY
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LEAVE BLANK. THIS WILL BE FILLED OUT AT THE ROTC DETACHMENT

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