Marine Corps Screening Form

Full Name

First NameMiddle NameLast Name

Please select your Gender

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

Date

High School:

Current Grade:

Weight

ex. 175

Height

ex. 5'7 or 67 inches

Police Involvement to include tickets or juvenile record

Tattoos, Brandings, Piercings?

If tattoos, are they located on

Drug use

Medical History (Current or past history of)

Which best represents your current level of physical fitness?

What would interest you about the Marine Corps? (Select all that apply)

Did you know the Marine Corps will pay 100% tuition for college?

What do you plan on doing with your future after graduation?

Would you like to schedule an appointment?

When is the best time to contact you?

Appointment

Why Marines?