Full Name
*
First Name
Middle Name
Last Name
Please select your Gender
*
Male
Female
Current City, State
*
ex. Louisville, KY
Place of Birth: Country,State,County,City
*
Ex. U.S, KY, Jefferson, Louisville
Phone Number:
*
E-mail:
Birth Date
*
-
Month
-
Day
Year
Date
High School:
Current Grade:
*
Freshman
Sophomore
Junior
Senior
Graduate
Weight
*
ex. 175
Height
*
ex. 5'7 or 67 inches
Police Involvement to include tickets or juvenile record
*
Yes
No
Tattoos, Brandings, Piercings?
Yes
No
If tattoos, are they located on
Hands
Face
Neck
None of the Above
Drug use
Would test positive
Past use (Clean)
Never
Medical History (Current or past history of)
*
Surgeries / Operations
Self-Harm
Vision/Glasses
Implants (pins, plates)
Broken Bones
Asthma/Inhaler Usage
Medication Usage (ADHD, Depression, Anxiety)
ER Visits
Skin (ex. Eczema)
Counseling
NONE OF THE ABOVE
Other
Which best represents your current level of physical fitness?
My physical fitness needs some improvement
I work out sometimes (less than 3 days per week)
I work out often (3-5 days per week)
I am very physically fit
I am a physical fitness master
What would interest you about the Marine Corps? (Select all that apply)
Challenge
Self-Direction, Self- Discipline, and Self Reliance
Leadership and Management Skills
Financial Security
Professional Development
Education Benefits
Travel and Adventure
Physical Fitness
Pride of Belonging
Courage, Poise, Self-Confidence
Patriotism
Advancement/Promotions
Early Retirement
Free Medical, Dental, Meals, Housing
Technical Skills
Electronics
Military Police
Auto Mechanic
Aircraft Maintenance
Computer Systems
Supply/ Accounting
Radio Communication
Musician
Crash and Fire Rescue
Infantry
Aviation Ordinance
Radar Repair
Finance
Legal Services
Avionics
Business Administration
Weather Services
Martial Arts
Construction
Special Ops
Linguistics
Welding
Did you know the Marine Corps will pay 100% tuition for college?
Yes
No
What do you plan on doing with your future after graduation?
Would you like to schedule an appointment?
*
Yes
No, I just want to see if I qualify
When is the best time to contact you?
Morning
Afternoon
Evening
Appointment
Why Marines?
Submit
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