Are you basically qualified?
Name
*
First Name
Last Name
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
School Year Currently In
*
Please Select
Freshman
Sophomore
Junior
Senior
High School Graduate
Are you a high school graduate?
*
Yes
No
Current Age
*
Please Select
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Any Interest in the military?
*
Yes
No
Undecided
Height
*
Please Select
4'10"
4'11"
5'0"
5'1"
5'2"
5'3"
5'4"
5'5"
5'6"
5'7"
5'8"
5'9"
5'10"
5'11"
6'0"
6'1"
6'2"
6'3"
6'4"
6'5"
Weight (Approximate)
*
Any drug use? (e.g. marijuana, cocaine, etc.)
*
Yes
No
Any medication? (e.g. ADHD, anti-depressants, anxiety, etc.)
*
Yes
No
Have you ever broken a bone?
*
Yes
No
Have you ever had asthma or been prescribed an inhaler?
*
Yes
No
Do you have any allergies that require an EpiPen? (e.g. shellfish, bees, etc.)
*
Yes
No
Do you have any tattoos, brandings, or piercings?
*
Yes
No
Do you wear glasses or contacts?
*
Yes
No
Have you ever any kind of police involvement, including traffic violations?
*
Yes
No
Submit
Should be Empty: