How did you find out about our program?


Name*:


GSU Email Address (or other email):


Eagle ID:


Date of Birth


Birth Place


Local telephone number


Local address


Home of Record Telephone


Home of Record Address


SAT / ACT (1000 or above for GSU)


GPA (2.0 non-scholarship; 2.5 scholarship) as of

College hours completed:


Academic Major:


Height and Weight:


Physical Problems (hospitalized after birth):


US Citizen? Yes   No

Used drugs? Yes   No

Law violations? (over $250 ticket, civil convictions)


Marital Status (max 3 dependents; spouse and 2 children):


Number of children?


Are you prior service? Yes   No

MOS


RE Code


National Guard Unit


USAR Unit


Participate in JROTC? Yes   No  

If participated in JROTC, what school?


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