Marine Officer Eligibility Form
Capt Nicholas Brediger, USMC
Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date Of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
College/University
Graduation Date (Month and Year)
Major
Place of Birth
Gender
Ethnicity
Marital Status
Do you have children? If so, how many?
US Citizenship Status?
Current Enrollment Status (number of credits)
Last Semester GPA
Cumulative GPA
SAT Score (Math and Reading Combined) or ACT Composite Score
LSAT Score (If Applicable)
Height
Weight
Current Vision
Is your vision correctable to 20/20
Have you ever been diagnosed with asthma and/or prescribed an inhaler?
Have you ever ben diagnosed with any allergies?
Are you currently and/or have you ever taken prescription medication? If so, what type(s) and for what reason(s)?
Have you ever been hospitalized? If so, for what reason(s)?
Have you ever had any surgeries? If so, for what reason(s)?
Have you ever been treated by a psychiatrist and/or psychologist? If so, for what reason?
Do you have any tattoos? If so, what and where?
Do you have any body piercings other than your ears?
Do you have any parking and/or speeding tickets? If so, how many and has your license ever been suspended?
Have you ever been charge with and/or convicted of a crime? If yes, please explain.
Have you ever tried marijuana? If so, how many times and when most recently?
Have you ever tried any other, illegal drugs?
Have you ever applied for or served in any of the armed services before? If so, please explain.
Do you have any family in the military?
Do you exercise on a regular basis? If so, please explain
How many pull-ups can you do?
What is your current, approximate 3 mile run time?
What are you most interested in pursuing? (e.g. aviation, ground, law, reserve, etc.)
What is most important to you? (pick 3 most important)
Rows
Less Important
Important
Most Important
Challenge
Leadership Management/Training & Experience
Career Variety
Tuition Assistance
Financial Security, Advancements, & Benefits
Equal Opportunity
Self-Reliance, Discipline, Responsibility
Physical Fitness
Pride & Honor Of a Marine Commission
Professional Development & Personal Growth
Travel & Adventure
Patriotism
Post-Graduate Education
What is a good day/time to discuss the Marine Officer Program?
Submit
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