Marine Corps Screening Form

Full Name

First NameLast Name
Gender
Current City, State
e.g. Louisville, KY
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
E-mail:
Place of Birth: Country, State, County, City
e.g. U.S, KY, Jefferson, Louisville
Birth Date

MonthDayYear
High School:
Current Grade:

Other
Please Explain
Height
ex. 5'7 or 67 inches
Weight
ex. 175
Police Involvement to include tickets or juvenile record?
Please Explain
Tattoos, Brandings, Piercings?
If tattoos, are they located on
Drug use
Medical History (Current or past history of)

Other
Please Explain
Which best represents your current level of physical fitness?
What would interest you about the United States 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?
Would you like to schedule an appointment?
When is the best time to contact you?
Why Marines?
How did you hear about the Marines?
e. g. friends, family, ad
Should be Empty: