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NROTC Preparatory Program Application

NROTC Preparatory Program Application

Step 1 of 7 - Personal Information

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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)

MM slash DD slash YYYY

Preferred Name

Gender(Required)

Male

Female

Email(Required)

Phone Number(Required)

Permanent Address(Required)

Street Address Address Line 2 City

State

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Alabama

Alaska

American Samoa

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

District of Columbia

Florida

Georgia

Guam

Hawaii

Idaho

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Indiana

Iowa

Kansas

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Maryland

Massachusetts

Michigan

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New York

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Northern Mariana Islands

Ohio

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Pennsylvania

Puerto Rico

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

U.S. Virgin Islands

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

Armed Forces Americas

Armed Forces Europe

Armed Forces Pacific

State ZIP Code

CITIZENSHIP

Place of Birth

City State / Province / Region

Country

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Please Choose

Afghanistan

Albania

Algeria

American Samoa

Andorra

Angola

Anguilla

Antarctica

Antigua and Barbuda

Argentina

Armenia

Aruba

Australia

Austria

Azerbaijan

Bahamas

Bahrain

Bangladesh

Barbados

Belarus

Belgium

Belize

Benin

Bermuda

Bhutan

Bolivia

Bonaire, Sint Eustatius and Saba

Bosnia and Herzegovina

Botswana

Bouvet Island

Brazil

British Indian Ocean Territory

Brunei Darussalam

Bulgaria

Burkina Faso

Burundi

Cabo Verde

Cambodia

Cameroon

Canada

Cayman Islands

Central African Republic

Chad

Chile

China

Christmas Island

Cocos Islands

Colombia

Comoros

Congo

Congo, Democratic Republic of the

Cook Islands

Costa Rica

Croatia

Cuba

Curaçao

Cyprus

Czechia

Côte d'Ivoire

Denmark

Djibouti

Dominica

Dominican Republic

Ecuador

Egypt

El Salvador

Equatorial Guinea

Eritrea

Estonia

Eswatini

Ethiopia

Falkland Islands

Faroe Islands

Fiji

Finland

France

French Guiana

French Polynesia

French Southern Territories

Gabon

Gambia

Georgia

Germany

Ghana

Gibraltar

Greece

Greenland

Grenada

Guadeloupe

Guam

Guatemala

Guernsey

Guinea

Guinea-Bissau

Guyana

Haiti

Heard Island and McDonald Islands

Holy See

Honduras

Hong Kong

Hungary

Iceland

India

Indonesia

Iran

Iraq

Ireland

Isle of Man

Israel

Italy

Jamaica

Japan

Jersey

Jordan

Kazakhstan

Kenya

Kiribati

Korea, Democratic People's Republic of

Korea, Republic of

Kuwait

Kyrgyzstan

Lao People's Democratic Republic

Latvia

Lebanon

Lesotho

Liberia

Libya

Liechtenstein

Lithuania

Luxembourg

Macao

Madagascar

Malawi

Malaysia

Maldives

Mali

Malta

Marshall Islands

Martinique

Mauritania

Mauritius

Mayotte

Mexico

Micronesia

Moldova

Monaco

Mongolia

Montenegro

Montserrat

Morocco

Mozambique

Myanmar

Namibia

Nauru

Nepal

Netherlands

New Caledonia

New Zealand

Nicaragua

Niger

Nigeria

Niue

Norfolk Island

North Macedonia

Northern Mariana Islands

Norway

Oman

Pakistan

Palau

Palestine, State of

Panama

Papua New Guinea

Paraguay

Peru

Philippines

Pitcairn

Poland

Portugal

Qatar

Romania

Russian Federation

Rwanda

Réunion

Saint Barthélemy

Saint Helena, Ascension and Tristan da Cunha

Saint Kitts and Nevis

Saint Lucia

Saint Martin

Saint Pierre and Miquelon

Saint Vincent and the Grenadines

Samoa

San Marino

Sao Tome and Principe

Saudi Arabia

Senegal

Serbia

Seychelles

Sierra Leone

Singapore

Sint Maarten

Slovakia

Slovenia

Solomon Islands

Somalia

South Africa

South Georgia and the South Sandwich Islands

South Sudan

Spain

Sri Lanka

Sudan

Suriname

Svalbard and Jan Mayen

Sweden

Switzerland

Syria Arab Republic

Taiwan

Tajikistan

Tanzania, the United Republic of

Thailand

Timor-Leste

Togo

Tokelau

Tonga

Trinidad and Tobago

Tunisia

Turkmenistan

Turks and Caicos Islands

Tuvalu

Türkiye

US Minor Outlying Islands

Uganda

Ukraine

United Arab Emirates

United Kingdom

United States

Uruguay

Uzbekistan

Vanuatu

Venezuela

Viet Nam

Virgin Islands, British

Virgin Islands, U.S.

Wallis and Futuna

Western Sahara

Yemen

Zambia

Zimbabwe

Åland Islands

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

ACADEMIC INFORMATION

School(Required)

Search and select the most recent high school you attended in the box below. If your school is not found in the search, please type its full name and press enter. If you were homeschooled, please type “N/A,” press enter, and select the “Home School” option in the “Type of School” field below.

Type of School(Required)

Public

Private

Correspondence

Charter

Home School

Other

School Address(Required)

Street Address City

State

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Alabama

Alaska

American Samoa

Arizona

Arkansas

California

Colorado

Connecticut

Delaware

District of Columbia

Florida

Georgia

Guam

Hawaii

Idaho

Illinois

Indiana

Iowa

Kansas

Kentucky

Louisiana

Maine

Maryland

Massachusetts

Michigan

Minnesota

Mississippi

Missouri

Montana

Nebraska

Nevada

New Hampshire

New Jersey

New Mexico

New York

North Carolina

North Dakota

Northern Mariana Islands

Ohio

Oklahoma

Oregon

Pennsylvania

Puerto Rico

Rhode Island

South Carolina

South Dakota

Tennessee

Texas

Utah

U.S. Virgin Islands

Vermont

Virginia

Washington

West Virginia

Wisconsin

Wyoming

Armed Forces Americas

Armed Forces Europe

Armed Forces Pacific

State ZIP Code

Guidance Counselor Information

Name(Required)

First Last

Email(Required)

Phone

Fax

Are you currently Enrolled in School?(Required)

Yes

No

Will/did you graduate from High School?(Required)

Yes

No

Current Year’s Course

Please list name, level (Honor, AP, IB, etc.) and credit value

Semester #1 / Trimester #1

Semester #2 / Trimester #2

Trimester #3

Other Schools

List all other high schools, colleges/universities (including summers, and academic programs you attended, beginning with ninth grade). You must submit transcripts from each school.

School Name

CEEB Code

Dates Attended

Location

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)

Extracurricular activities

Please list any significant extracurricular or community activities and hobbies in which you have participated. Include specific accomplishments such as musical accolades, athletic distinctions, etc. (Please note “PG” means Post-Graduate)

Activity

Grade Level (9,10,11,12,PG)

Specific Accomplishments

Hours/ Week

Week/ Year

Will you participate in College? (Yes, No, Unsure)

Employment Information

List any work experience (including summer jobs) during the past three years

Employer

Job Description

Date of Employment

Hours / Week

Military Affiliation

check all that apply

Dependent of US Veteran

Dependent of Active US Military

Branch Affiliation

Army

Navy

Air Force

Marines

Coast Guard

Are you applying to any service academies or other ROTC Programs?(Required)

Yes

No

If yes, explain(Required)

Have you ever been rejected for any reason for service in any branch of the military?(Required)

Yes

No

If yes, explain(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.

Max: 500 words

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

Max: 500 words

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.

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EQUAL OPPORTUNITY POLICY FOR STUDENTS Regent University does not discriminate on the basis of race, color, sex, national or ethnic origin, disability, age or veteran status in admissions, treatment or access to its programs and activities, or in the administration of educational policies, scholarships, loan programs, athletics or other University programs. In addition, Regent does not discriminate based on religion, except as necessary to comply with Regent’s Standard of Personal Conduct and Statement of Christian Community and Mission. Telephone Consumer Protection Act (TCPA) Terms & Conditions By submitting your information and telephone number through the above “Request Information” form and clicking “Learn More” to request information (“Inquiry”), You agree that Regent University (“Regent”) and all of its related corporate entities, agents, independent contractors, assigns, and successors may call You through the use of any dialing equipment (including a dialer, automatic telephone dialing system, and/or interactive voice recognition system) and/or artificial or prerecorded voice or message, even if You are charged for the call or message. You expressly agree that such automated calls may be made by Regent and/or its related corporate entities, agents, independent contractors, assigns, and/or successors to any telephone number (including numbers assigned to any paging, cellular, or mobile service, or any service for which You are charged for the call) You have provided previously or may provide in the future in connection with Your Inquiry. You expressly consent to such automated calls. With such consent, You specifically waive any claim You may have against Regent and/or its related corporate entities, agents, independent contractors, assigns, and/or successors for the making of such calls, including any claim under federal or state law and specifically any claim under the Telephone Consumer Protection Act, 47 U.S.C. § 227. You also expressly agree that this provision applies to the use of text messaging. You expressly consent to the receipt of text messages from Regent and all of its related corporate entities, agents, independent contractors, assigns, and successors at any telephone number (including numbers assigned to any paging, cellular, or mobile service, or any service for which You are charged for the call) You have provided previously or may provide in the future in connection with Your Inquiry. You are not required to accept this consent to obtain any good or service.

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