Name: / SSN:
(Last First Middle) / ( XXX - XX -XXXX ) Entire number
Yes / No
  1. Are you an NROTC scholarship student?

  1. Are you a full-time student (taking 12 or more hours)?

  1. Are you a US citizen?

  1. Do you have eye vision corrected to 20/20?

  1. Are you color blind?

  1. Do you have any physical disabilities?

  1. Have you ever been arrested or convicted of a felony?

  1. Have you ever taken illegal drugs?

9. Select your service option: /  Navy  Marine / 9.a. Legal resident of what state:
10. Date of birth: / 11. UIN: / 11.a. Place of birth:
12. Date enrolled in NROTC: / 13. Texas A&M graduation date:
(month/year) / (month/year)
14. Rate your physical ability: / Outstanding Excellent Fair Poor
15. Classification in Corps: / Freshman Sophomore Junior Senior 5th Year
16. Academic major: / 17. Corps outfit:
(Specific Major, NOT General Studies)
18. Father’s name, address, and phone:
19. Mother’s name, address, and phone:
20. Your E-Mail Address:
21. Your Cell Phone Number:
22. JROTC you participated in high school: /  None  Air Force  Army  Navy Marines
23. Marital status: /  Single  Divorced  Married
24. Number of dependents you claim:
25. High school ranking in academics: /  Top 20%
 Top 40%
 Top 60%
 Top 80%
 Below Top 80%
26. Are you an Eagle Scout? /  Yes  No
(COMPLETE BACK OF THIS FORM)
27. Are you a child of a career military member? /  Yes  No
28. Type of high school: /  Public (graduating class more than 100)
 Public (graduating class less than 100)
 Private (graduating class more than 100)
 Private (graduating class less than 100)
29. Demographic type: /  Urban (city larger than 500,000
 Suburban (city less than 500,000)
 Rural (farming/county environment)
30. High school graduate or GED? /  High School  GED
31. Race: / (use DoD codes below)
32. Ethnic Group: / (use DoD codes below)
RACE CODES
DOD RACE / DOD RACE DESCRIPTION / DOD RACE / DOD RACE DESCRIPTION
1 / B,C,D, AND E COMBINED / K / A,B,C, AND D COMBINED
2 / B,C, AND E COMBINED / L / A,B,C,D, AND E COMBINED
3 / B AND D COMBINED / M / A,B,C, AND E COMBINED
4 / B,D, AND E COMBINED / N / A,B, AND D COMBINED
5 / B AND E COMBINED / P / A, B, D, AND E COMBINED
6 / C AND D COMBINED / R / A AND C COMBINED
7 / C,D,AND E COMBINED / S / A,C, AND D COMBINED
8 / C AND E COMBINED / T / A,C,D, AND E COMBINED
9 / D AND E COMBINED / U / A,C, AND E COMBINED
A / AMERICAN INDIAN OR ALASKA NATIVE / V / A AND D COMBINED
B / ASIAN / W / A, D, AND E COMBINED
C / BLACK OR AFRICAN AMERICAN / X / A AND E COMBINED
D / NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDER / Y / B AND C COMBINED
E / WHITE / Z / B,C, AND D COMBINED
H / A AND B COMBINED
J / A, B, AND C COMBINED
ETHNIC CODES
CODE / ETHNICITY DESCRIPTION / CODE / ETHNICITY DESCRIPTION
1 / HISPANIC / G / CHINESE
2 / AMERICAN INDIAN / J / JAPANESE
3 / ASIAN / K / KOREAN
4 / PUERTO RICAN / L / POLYNESIAN
5 / FILIPINO / Q / OTHER PACIFIC ISLANDER
6 / MEXICAN / S / LATIN AMERICAN HISPANIC
7 / ESKIMO / V / VIETNAMESE
8 / ALEUT / W / MICRONESIAN
9 / CUBAN / X / OTHER – NOT IN OPTIONS
D / INDIA INDIAN / Y / NONE
E / MELANESIAN / Z / UNKNOWN OR FAILED TO SPECIFY/
RESPOND

NROTC TAMU FORM 1030/1 (REV JU; 2011)