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Prospective Student On-line Worksheet

Please complete this form in order to receive further information about Army ROTC at the University of Wisconsin.

First Name:
Middle Name:
Last Name:
Address:
City:
State:
Country:
ZIP:
E-mail:
Gender:	Male Female
Home Phone:
Year of Birth:	(yyyy)
Interested in a Scholarship:	Yes No
Currently in the National Guard/Reserves?	Yes No
Prior Service?	Yes No
SAT/ACT Score:
Cumulative GPA:
Current Year in School/Service:
Currently in High School?	Yes No
What Year?
Currently in College?	Yes No
What Year?
Athletic/Extracurricular Involvement: