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:
Height:	(Feet/Inches)
Weight:
Date of Birth:	(mm/dd/yyyy)
Interested in a Scholarship:	Yes No
Currently in the National Guard/Reserves?	Yes No
ACT Score:
Cumulative GPA:
Current Year in School/Service:
Athletic/Extracurricular Involvement: