Last day to create online application phase 1 document submission. Principal purpose form is used to make application for a green to gold 4, 3, or 2year scholarship. Copies of the documentation andor supporting documents as indicated above have been provided to the cadet and. Ccf174r pg 1 for use of this form, see cc reg 1451, the proponent agency is atccopis data required by the privacty act of 1974. If the cadet is an rotc scholarshipparticipant, the scholarship will be in force for the number of semesters indicated in block 5. Cc form 7r, aug 02 to authorizedecline the release of any and all official records maintained by the rotc department to personnel in the department of defense and. The cc form 9r is not a contract that obligates the cadet to a career in the army. The documents provided below for download are in a variety of formats.
Questions about the ccform4, or general information or assistance on completing or filing a ccform4, may be directed to the workers compensation commission counselor division, 405 5228760 or instate toll free 800 5228210. Army rotc military science program cardinal battalion hosted at the university of louisville uofl supporting. Disclosure information provided on this form is mandatory. Scholarship form cc form 173r applicant snapshot form cc form 103r medical examination forms dd form 2351. As a current student on this bumpy collegiate pathway, i stumbled upon course hero, where i can find study resources for nearly all my courses, get online help from tutors 247, and even share my old. Active dutyreserve rotc applicant snapshot for use of this form see, cc reg 1451, proponent agency is atccopis appendix b authority 10 usc 2102 and 2107 principal purpose to physically identify. Usacc form 104r, sep southern california army rotc. Active duty application cc form 174r army green to gold. In part i where indicated print your first name, middle initial, and last name. The problem is, the online applicationwhich, according to the cadet command poc, is the only way i can fill out the newest cc form 174 r is inaccessible. Questions about the ccform4, or general information or assistance on completing or filing a ccform4, may be directed to the workers compensation commission counselor division, 405 5228760 or in. Routine uses form is used to obtain selection and eligibility information on applicants for a 2year green to gold active duty option program. Authorization for access to student records cc form 7 r.
Have cc form 104r planned academic program worksheet which indicates 2 or 3 years remaining 4 semesters6 quarters for 2year applicants or 6 semesters9 quarters for 3year applicants as a full. Data required by the privacy act of 1974 10 usc 2102 and 2107. How to prepare a planned academic worksheet cc form 104r the cc fm 104r is completed for each prospect you are working into the program to ensure academic alignment. Cadet command form 104r planned academic program worksheet must be fully typed, signed by academic advisor, signed by the cadet and turned. Enrolled rotc cadets and applicants for enrollment who suffer. Cc form 228r nco evaluation report da form 21668 test phone.
Green to gold rotc active duty option program application cc form 174 r. Cc form 9 r cadet enrollment record excel cc form 6 r briefing of government benefits pdf cc form 7 r release of student. Form is used to obtain selection and eligibility information on applicants for a 2year green to gold active duty option program. I certify that the waiver of rights documentation has been completed iaw cc pam 1454. Briefing on government sponsored benefits for rotc cadets rotc cadet cmd pam 1454 i have been briefed this date on governmentsponsored benefits for rotc cadets and understand that.
Cc form 173r, jun 09 a1 page 1 of 2 state briefly why you desire to receive a commission as an army officer and pursue a military career. The intent of this form is to input the data on the pc to prevent errors, especially in the formulas. The problem is, the online applicationwhich, according to the cadet command poc, is. How to prepare a planned academic worksheet cc form. Application cc form 174r green to gold active duty optioncc form 173r scholarship signed and dated by individual verified by milpo signed and dated by commanding officer and field grade. Cc form 7 r, aug 02 to authorizedecline the release of any and all official records maintained by the rotc department to personnel in the department of defense and. Statement as to the applicants performance on active duty and potential to be eligible and qualified to receive a regular army commission, if offered. Forms basic course initial enrollment forms these forms are to be filled out by applicants that are seeking to contract andor seek a scholarship. It is the proper registration information that is required for continued. Statement as to the applicants performance on active duty and potential to be eligible and qualified to. Im currently putting my packet together for the units hip pocket scholarship, which is due february 2nd. Nebraska state court form required plaintiffs claim and. If date specified is a reenlistment date, indicate period of original enlistment enter as yymmdd 2mile run 1 u. For use of this form see, cc reg 1451, proponent agency is atccoi.
Army rotc green to gold application status notification. Data required by the privacy act of 1974 authority 10 usc 2102 and 2107. Date mmddyyyy usacc form 104 r, sep page 3 of 3statement of understandingplanned academic program worksheetfor use of this form, see usacc pam 1454, the proponent agency is atccpacfull name, last, first. Ccf174 r pg 1 for use of this form, see cc reg 1451, the proponent agency is atccopis data required by the privacty act of 1974. All contracting cadets need to read this thoroughly. Part vi applicant statement rank last name first name ssn 4. Cc form 174 r green to gold active duty option application 41. You are covered medically under federal workers compensation for injury while traveling to and from, and during rotc training as long as you are registered as a fulltime student and properly enrolled in rotc. Army rotc scholarship acceptancedeclination statement and pms validation for use of this form, see cc reg 1451, the proponent agency is atccopis data required by the privacy act of 1974 authority 10 usc 2101 and 2107.
Army rotc green to gold active duty option program application for use of this form, see cc reg 1451, the proponent agency is atccopis data required by the privacty act of 1974. Section 10194 of the omaha municipal code and the rules and regulations based thereon require. How to prepare a planned academic worksheet cc form 104r. It is a requirement for any cadet that enrolls in the program to complete within their first semester. This gives the government access to your student records. If not already listed, print the name of the school you are attending.
Have cc form 104 r planned academic program worksheet which indicates 2 or 3 years remaining 4 semesters6 quarters for 2year applicants or 6 semesters9 quarters for 3year applicants as a fulltime student to degree completion summer sessions are authorized but cannot interfere with advance camp attendance. Routine uses form is used to obtain selection and eligibility information on applicants for 4, 3, or 2year scholarships. Application cc form 174 r green to gold active duty option cc form 173 r scholarship signed and dated by individual verified by milpo signed and dated by commanding officer and field grade commander applicant snapshot cc form 103 r deployed soldiers may send polaroid with copies of deployment orders. Applicable to injuries deaths occurring on or after 2114. Documents saved as pdf files can be viewed and printed from any windows, dos, unix, mac, or os2 platform that has acrobat reader software free from adobe systems, inc. Cc form 104 r, dec 04 page 3 of 3 full name, last, first, mi name of university or college statement of understanding professor of military science signature type of degree cadet signature planned academic program worksheet for use of this form, see cc pam 1454, the proponent agency is atccpac 0 0 0. Cc form 104r form army rotcmilitary science program.
The green to gold scholarship program is a program that provides eligible, regular army ra enlisted soldiers. The plaintiff fills out the claim form and signs it in. Disclosure information provided on this form is mandatory, without the data provided on this form, the application cannot be considered for participation into this program. You are covered medically under federal workers compensation for injury while traveling to and from, and during rotc training as long as you are registered as a fulltime student and properly enrolled in. Below is a list of the most current united states army cadet command forms, checklists, policies, pamphlets, sops and regulations. Cc form 104r is a cadets academic plan to graduate. For use of this form, see cc reg 1451, the proponent agency.
Copies of the documentation andor supporting documents as indicated above have been provided to the cadet and the cadet has been afforded an opportunity to comment. Cc form 174 r, nov 08 a2 page 2 of 2 statement as to the applicants military aptitude and motivation. Da form 80 record of individual performance of reserve duty training. Cc form 203 r guaranteed reserve forces duty grfd scholarship cadet contract endorsement learn to lead commissioned officers are responsible for completing demanding missions while ensuring the welfare, morale, and professional development of the soldiers entrusted to them. When printing the name of your parents put their first and last name example. Cadet enrollment record cc form 9r green to gold rotc scholarship application cc form 173r.
They are to be submitted in person, at our offices. Cc form 104 r is a cadets academic plan to graduate. Cc form 104r, dec 04 page 3 of 3 full name, last, first, mi name of university or college statement of understanding professor of military science signature type of. Cc form 203r guaranteed reserve forces duty grfd scholarship cadet contract endorsement learn to lead commissioned officers are responsible for completing demanding missions while ensuring the. Send original to workers ompensation ommission and 1 copy to insurance arrier.
If additional space is required, attach another sheet. Scholarship form cc form 173 r applicant snapshot form cc form 103 r medical examination forms dd form 2351. Cc form 2r statement of understanding cc form 174r green to gold active duty option program application cc form 228r financial statement da form 705 army physical fitness test. Financial statement cc form 228r army green to gold. Nebraska state court form required plaintiffs claim. For use of this form, see usacc reg 1451, the proponent. Rotc cadet cmd pam 1454 i have been briefed this date on governmentsponsored benefits for rotc cadets and understand that1. It is recommended that you have the latest version of adobe acrobat reader 4. Cadet enrollment record cc form 9 r green to gold rotc scholarship application cc form 173 r. Army rotc green to gold 4, 3, and 2year scholarship application for use of this form, see cc reg 1451, the proponent agency is atccroi data required by the privacy act of 1974. State briefly why you want to become an army officer. If you are injured during rotc training and require medical treatment you must within 10 days see your rotc admin office.
View cc form 104r form from ecog 203 at howard university. Appendix b active dutyreserve rotc applicant snapshot. Cc form 174r, nov 08 a2 page 2 of 2 statement as to the applicants military aptitude and motivation. Chapter 6, article 14 nebraska state court form required. Timeinserivce da form 4187 statement of understanding cc form 2 r.
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