ROTC Contracting Packet

Application Checklist – This is a checklist of every form needed in order to contract with the ROTC program

104-R- This form is an academic plan / worksheet. It should contain all of the classes you need to complete your bachelor’s degree, as well as, all of the required ROTC classes. You ROTC instructor will advise you on the best method for getting this document completed. It will require a signature from your academic advisor acknowledging courses needed to complete your degree. This Excel Spreadsheet has three tabs / pages that must be completed. Page two, block number 12 must be signed by your academic advisor.

139-R – This is a cadet enrollment record form. The form has 6 tabs/pages in the bottom left corner; however, only the first 2 tabs need to be completed for contracting purposes. The following is a list of items that may help you when filling out the form:

  • Block # 9: DOB - Date of Birth
  • Block # 10: POB – Place of Birth
  • Block # 24: Next of Kin- who would we contact in an emergency
  • Block # 25a / 26a: FICE code – do not fill this in
  • Tab/page #2: Initial one box in each section (blocks #42-46) on the second tab.
  • You must sign tab/page #2 where is states "All information given on this form is correct to the best of my knowledge."

SAL Sheet – Scholar Athlete Leader sheet. You only need to provide hair color, eye color, and blood type at the bottom of the form.

Language questionnaire – answer each question/section.

PME Requirements – Read all the PME Requirements and sign the second page saying you understand the requirements

Dental Form – Need to know the location of your dental x-rays; for emergency purposes only. You are the person that signs this form. ***Do not bring me your dental x-rays.

DD 93 – This is a Record of emergency data. Fill out the first two pages; if you need any instruction for how to fill out any part of these forms pages 3 and 4 contain instruction.

SGLI – The Servicemembers’ Group Life Insurance Election and Certificate. Only need page two filled out. The additional forms are provided to ensure you understand the purpose and how to complete the form. Fill out your personal information at the top of page 2, elect if you want the life insurance, or want to reduce the amount, and list beneficiaries. Sign and date the bottom of the form.

SF 1199A – Direct Deposit form needs to be filled out and turned in in-order to receive direct deposits. You only need to fill out and print page one.

  • Section 1 (A,D, & E): completed by the Cadet and must sign first signature block in that section.
  • Section 3: Completed by the students bank official. Must have bank official’s signature; only exception is if you bank with USAA in Texas.

W4 – Tax form (with holdings: current year)

DD Form 2058 – State of Legal Residency Form. Fill in name, SSN, and your legal mailing address. Sign and date the bottom

CC 136 – Government Sponsored Benefits for ROTC Cadets. Sign and date the bottom of the form. This indicates that you have read and understand the information on the form.

CC 137 – Authorization for access to student records.

  • Fill out part 1 if you would want to authorize an ROTC instructor to speak with your parents about your performance, to include grades, should they contact us.
  • Fill out part 2 if you do not want us to discuss your performance with your parents/legal guardian.

3425-R – Medical fitness statement. Go to your physician and have that physician fill out this form stating you have no medical conditions or physical impairments that may hinder your participation in ROTC.

DD Form 2005 – Privacy Statement for healthcare Records, Read form and sign and date the bottom.

Pre-contract Checklist – This checklist will be completed in conjunction with your ROTC instructor at the time of contracting; it does not need to be completed prior to contracting.

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