NROTC Preparatory Program Application

PERSONAL INFORMATION

Please enter your name as it appears on your passport or official document

Name(Required)

First Middle Initial Last

Date of Birth(Required)

Preferred Name

Gender(Required)

Male

Female

Email(Required)

Phone Number(Required)

Permanent Address(Required)

Street Address Address Line 2 City State ZIP Code

CITIZENSHIP

Place of Birth

City State / Province / Region Country

Citizenship Status(Required)

US Citizen

US Permanent Resident

Other

Please Upload Proof of citizenship(Required)

Proof of citizenship may include a photocopy of a birth certificate or U.S. passport.

Drop files here or

Accepted file types: jpg, png, pdf, Max. file size: 20 MB.

Alien Registration Number(Required)

If you live in the US, but are not a US citizen, how many years have you lived in the country?

years

If not English, what language is primarily spoken in your home?

If not English, what is your first language?

ETHNICITY

Race/Ethnicity information is optional. Information you provide will not be used in a discriminatory manner and will not be used as a factor for selection or disqualification.

Are you Hispanic or Latino/a?

Yes

No

If yes, Country of Origin

Race

Asian

Native Hawaiian or Other Pacific Island

Black or African American

White

American Indian or Alaska Native

Other

Advanced Placement or International Baccalaureate exams

Subject

Test Date

Score

Standardized Test Information

Standardized tests are optional but encouraged for NPP applications.

SAT

Test Date

Evidence Base Reading /Writing

Math

Optional Essay

ACT

Test Date

English

Reading

Science

Composite

Optional Essay

Math

ASVAB

Test Date

AFQT Score

Academic Distinctions

Please list any academic or education awards and honors you received in high school (National Merit, National Honor Society)

Height(Required)

Weight(Required)

Are you able to swim?(Required)

Yes

No

How frequently do you swim?(Required)

Less than once a month

3-5 times a month

More than 5 times a month

AFA Information

The official score sheet for the AFA will be submitted separately.

Planks/Crunches(Required)

Push-ups(Required)

1 mile run(Required)

Observer name(Required)

First Last

Observer job title(Required)

Observer phone number(Required)

Essay 1(Required)

Have you experienced any adversity in your life (e.g., parents divorced, single parent family, multiple high schools, frequent moves, financial instability, etc.). If so, describe the circumstances and how you met the challenge. 500 words max.

Essay Response(Required)

Discuss your reasons for wanting to become a Naval Officer. Specifically comment on leadership position you have held, the challenges you have faced, and the lessons you have learned. 500 words max

Discipline Information

Have you ever been placed on probation, suspended, removed, dismissed or expelled from any school or academic program since 9th grade?(Required)

Yes

No

If you answered yes(Required)

Please provide an explanation and the approximate dates of each incident below

Other than traffic offenses, have you ever been convicted of any misdemeanor, felony, or other crime?(Required)

Yes

No

If you answered yes(Required)

Please provide an explanation and the approximate dates of each incident below

Additional Information

‘Please upload a full-length photo (wearing JROTC uniform, if applicable)(Required)

Accepted file types: jpg, png, pdf, Max. file size: 20 MB.

Verification

Your signature below confirms all information in this application (including any supplemental information) is factual and honestly presented and that you are the person submitting this application. Submitting this application constitutes your express written consesnt to be called and /or texted by Regent University at the number(s) your provided. You understand that these calls may be generated using automatic technology. No purchase required.

Signature

PERSONAL INFORMATION

CITIZENSHIP

ETHNICITY

ACADEMIC INFORMATION

Guidance Counselor Information

Standardized Test Information

AFA Information

Discipline Information

Verification