DEPARTMENT OF MILITARY SCIENCE · ARMY ROTC

Forms & Contracting Documents

Everything you need to enroll and contract with the Jackson State University Army ROTC program. Select a form to download it.

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Cadet Resources

Enrollment & contracting forms

This page contains the forms needed to enroll and contract with JSU Army ROTC. Forms are provided as PDF (.pdf), Excel (.xls), or Word (.doc) files, which open with freely available software such as OpenOffice and Adobe Acrobat Reader.

Note: If you have trouble opening a PDF in your browser, save the file to your computer and open it with Adobe Reader.

Contracting checklist: The documents below are needed to contract with JSU Army ROTC. For any questions, contact Mr. Rodney Hall, Recruiting Operations Officer.
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Forms by category

Items marked “Cadet-provided” are documents you bring rather than download.

Packets

Scholarship Contracting PAK 2020
Complete scholarship contracting packet.
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Non-Scholarship Contracting PAK 2020
Complete non-scholarship contracting packet.
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Basic Enrollment Forms

CC Form 136-R
Briefing on Government Sponsored Benefits for ROTC Cadets.
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CC Form 137-R
Authorization / Declination for Access to Student Records.
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CC Form 139-R
Cadet Application and Enrollment Record.
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CC Form 104-R
Planned Academic Worksheet.
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DD Form 2005
Privacy Act Statement — Health Care Records.
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Additional Requirements

DD Form 2351
DoDMERB Report of Medical Examination.
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DD Form 2492
DoDMERB Report of Medical History.
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DA Form 705
Army Physical Fitness Test Scorecard.
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Fast Start Form (007)
Army ROTC Fast Start form.
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145-4-1 Consent and Release (3-31-15)
Consent and release form.
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Transcripts
Unofficial; must show cumulative GPA.
Cadet-provided
Birth Certificate
Original or certified copy.
Cadet-provided
Social Security Card
Original card.
Cadet-provided
Shots & Immunization Records
Current immunization records.
Cadet-provided

Finance Forms

SF 1199A
Direct Deposit form.
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W-4
Most recent Employee’s Withholding Certificate.
Cadet-provided
DD Form 2058
State of Legal Residence Certificate.
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DD Form 93
Record of Emergency Data.
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SGLV 8286
SGLI Election Certificate.
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SMP / National Guard Only

DD Form 4
Enlistment Contract.
Cadet-provided
DD Form 214 / DD Form 220
Service records.
Cadet-provided
NGB Form 594-1
SMP Agreement — ARNG.
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DA Form 4824-R
Addendum to Certificate and Acknowledgement of Service Requirements for USAR personnel applying for ROTC SMP.
Download →

Miscellaneous Forms & References

Basic Camp Handbook
Cadet Basic Camp handbook.
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Advanced Camp Handbook
Cadet Advanced Camp handbook.
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DA Form 31
Request and Authority for Leave.
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Ready to get started?

Request more information or explore Army ROTC scholarships at JSU.

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Contact Army ROTC

Location & Address
4th Floor, College of Liberal Arts
1400 John R. Lynch Street, PO Box 17569
Jackson, MS 39217-0369
Phone & Fax
(601) 979-8600
Fax: (601) 979-9870
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