MARINE CORPS SCREENING FORM
Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Instagram Handle
Address
Street Address
Apartment Number
City
State / Province
Postal / Zip Code
Gender
Male
Female
Are you a High School graduate or GED equivalent?
Yes
No
Are you currently attending college?
Yes
No
If yes, what school?
ex. Kingsborough Community College
How old are you?
Select your Birth Date
-
Month
-
Day
Year
Date
Are you a permanent resident or a US citizen?
Permanent resident (Green Card Holder)
US Citizen
Height
ex. 5'7 or 67 inches
Weight
ex. 165
Last time of Marijuana Usage
None
1-30 Days
30-90 Days
90-180 Days
180+ Days
Any other drug use?
Yes
No
If yes, what type and last usage?
ex. speed
Would you pass a standard health physical?
Yes
No
I'm not sure
Do you have tattoos?
Yes
No
If so where are they located?
Which best represents your current level of physical fitness?
My physical fitness needs some improvement.
I work out sometimes (less than 3 days a week)
I work out often (3-5 days a week)
I am very physically fit
I am a beast
What would interest about the Marine Corps?
Challenge
Travel and Adventure
Financial Security and Benefits
Self-Direction, Self-Discipline, and Self-Reliance
Leadership and Management Skills
Technical Skills
Professional Development
Education Benefits
Physical Fitness
Pride of Belonging
Courage, Poise, Self-Confidence
Patriotism
Which program would you be interested in learning about?
Active Duty
Reserves
NROTC Scholarship
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