ROTC Interest Form

Reserve Officer Training Corps (ROTC)

Department Contact:
Mr. R. Ethan Allen
Senior Military Science Instructor
Email
Office Location:
Education Building Room 0107
812-461-5494

Interest Form

Basic Information

First Name*

Middle Name

Last Name*

Address*

City*

State*

Zip*

Phone

Email*

Birth Date

Education Information

Currently Enrolled in College? (check if yes)

College Major

Last Grade Completed

GPA on a 4.0 Scale

If interested in Eagle Detachment Army ROTC, which college will you attend? USI UE

Self Assessment of Physical Fitness Level

Cardiovascular

Muscular Strength and Endurance

Additional Information

Check if you are interested in more information about the National Guard and Reserve benefits

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Evansville, IN 47712
812-464-8600

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