Our program requires certain documents in order to participate outside of the classroom, compete for scholarships/Illinois State Tuition Waiver, or to work towards earning a contract. This page contains the necessary paperwork along with instructions. Please visit the Army Publishing Directorate (APD) website for additional forms, publications, etc.
In addition to these forms and documents we also require:
Please contact your instructor with any questions or concerns. Please note, per Army Regulation, we must keep the documents on file for a minimum of ten years.
The basic enrollment documents are required for students to participate outside of the classroom (e.g. freshmen are only required to attend their Military Science class but may also want to participate in physical training, leadership labs, etc.). These forms are for liability only, there is no commitment being made by completing them. Please note, if you cannot access the forms you may need to update Adobe. Please use the Instructions when completing the forms. Be sure to make note of any questions and we will address them at a later time.
Please keep in mind that this is not a "do it yourself" project. We strongly encourage the students to work with their instructor.
Cadet Application and Enrollment Record ( CC 139R (AUG 2019) ) is the most important form when initiating the enrollment process. Students cannot be entered in to our database with out the first two pages of this form being completed. Only complete the first two pages, the last four pages will be done at a later date with the Enrollment Officer. Please fill this form out to the best of your knowledge. If you are unsure of something please make note and let us know.
Academic Worksheet Plan (CC 104R) plays a major role in the contracting/scholarship process. Please use the step by step instructions and make note of any questions. The CIP Code is required for all Science/Technology/Engineering/Math (STEM) majors.
Medical Fitness Statement for Enrollment in Basic Course, Senior ROTC ( DA 3425 ) must be signed by a Healthcare Provider. Students who are DoDMERB qualified (not MEPS) DO NOT need to complete this form. Please contact Student Health Services for more information on scheduling appointments.
Army Senior ROTC/Junior ROTC Contract of Indemnification and Release/Waiver of Liability - generically states that you, the student, understand that there is an inherent risk of injury or death with no matter what you may do in life. Please ask if you have any questions with this form. Your first and last name are required on page one and complete the bottom of page two.
Briefing on Government Sponsored Benefits for ROTC Cadets (CC 136R) explains the benefits once the student has been entered in to our database. For example, "Enrolled ROTC cadets and applicants for enrollment who suffer illness/injury as a result of authorized (scheduled and supervised) training, or authorized travel to and from such training, are eligible for compensation through the Department of Labor/Department of Veteran Affairs".
Authorization/Declination for Access to Student Records (CC 137R) protects the students' academic records through the Family Educational Rights and Privacy Act (FERPA) of 1974.
Family Educational Rights Privacy Act (FERPA) Waiver - is required by the University Registrar in addition to the Cadet Command Form 137R. The "release is valid from..." should be the date you are completing the form through your graduation date. Please note that if this form is not completed with Army ROTC Cadre then it MUST be notarized.
State of Legal Residence form (DA 2058) is required in order to determine the State for which income taxes are to be withheld from your "wages". Please read the entire form before signing.
Police Record Check form (DD 369) is required of all applicants. If you have lived at more than one address over the years please list the address you have lived at the longest. ONLY fill out boxes 2-9 and sign box 11.
Dental Exam Requirements form allows students to be transported in a government vehicle. Without this completed form on file students are not authorized to be in a government vehicle. The ROTC Program needs nothing other than the information on this form. Please do not have x-rays or files sent to the office.
ISU Model Release form was created to protect your privacy rights when it comes to using your image. Please circle either "authorize" or "do not authorize" and complete the required information. Between our Facebook, website, slide shows, etc. we try to showcase our students involvement as much as possible.
Adult Photo Release Form is required in addition to the ISU Model Release form for Illinois State University Students.
Privacy Act Statement-Health Care Records form (DD 2005) protects your health care records from being shared outside of Army ROTC. A two-part medical exam is required in order to compete for scholarships, tuition waivers (after receiving it two times), and contracting.
Contracting documents are a part of the final phase before making a commitment to our ROTC Program and to the Army.
Direct Deposit form (SF 1199a) allows for the monthly stipend, book allowance, room/board, travel pay, etc. to be deposited directly to your bank account. This form is now required to enter students into our database. You only need to fill out page one. In box F select "other" and put ROTC on the line. Leave section 2 blank. Please fill in the information for section 3 if you know it and have your bank complete the certification boxes.
Record of Emergency Data form (DD 93) is used in the event of a casualty in order to expedite notification in the case of an emergency or death. Please read the instructions and fill out to the best of your knowledge. Your Instructor can assist with any questions.
Questionnaire for National Security (SF 86) is for a security clearance. Please review the changes prior to completing this form. In order to commission you must be eligible to receive a security clearance. DO NOT PRINT THIS FORM OUT! Save this to your computer and once completed email Mr. Snyder (email@example.com) and cc Mr. Sanford (firstname.lastname@example.org) letting him know you have completed the document. Because this document contains your Personally Identifiable Information (PII) we cannot accept it via email unless it is sent encrypted. If you have already been granted a security clearance for your MOS then we will verify and you do not need to complete the SF 86.
There are two rules you need to follow when completing this form, 1. Make sure you have your dates continuous. If it asks you where you lived, and you put from Aug 2012-May 2015, the next entry would have to be Jun 15. You can not have blank dates between events. 2. The program will ask who knew you when, you can not use the same person over and over and you can't use immediate family.
Servicemembers' Group Life Insurance Election and Certificate form (SGLV 8286) is optional. If you choose to elect the life insurance plan complete this to the best of your knowledge. If you choose NOT to elect this life insurance plan then follow the instructions under #2. Please review the SGLI Coverage Table for ROTC for more information on when coverage is in effect, for how long, etc.
Personal Allowances Worksheet (W-4). Please fill this out to the best of your knowledge and ask your Instructor/parents/guardian for help if needed.
Do you have questions about the paperwork? If so, then text or call Mr. Sanford at 309-287-1529 or email him at email@example.com.