NIU Army ROTC Information Request

Thank you for your interest in ROTC at Northern Illinois University. Please fill out as much information as possible.

Please note, an asterisk(*) denotes a required question.

Basic Information

Student's First/Given Name *

Student's Preferred First Name *

Student's Last Name/Surname *

Date of Birth *

Are you a current or prospective student?

Current Student (Currently enrolled at NIU)

Prospective Student (Planning to enroll at NIU in the future)

Contact Information

Email Address *

Permanent or Home Phone

Mobile Phone

Undergraduate Enrollment Information

I am a: *

NIU Program of Interest/Major: *

Students planning to pursue secondary education teacher licensure (grades 9 - 12) should select a major in the subject area field in which they intend to teach (such as English, History, Math, etc.) Please view niu.edu/educator-licensure/ for more information.

When do you plan to start at NIU? *

Are you an honors/AP student?

Yes

No

Which honor societies are you a member of?

Academic Information

Are you a full-time student?

Yes

No

What year are you?

What is your major?

GPA

Are you an Honors/AP student?

Yes

No

Are you a member of any honor societies?

General ROTC Information

If National Guard or USAR:

MOS

Unit

I am interested in:

General ROTC

Nursing

Science/Engineering

Marital Status

Are you a U.S. Citizen or U.S. National?

Yes

No

Do you have any legal dependents?

Yes

No

Have you ever been arrested or convicted of a crime?

Yes

No

Athletics

Have you ever been a member of a high school, city, regional or organized sport?

Yes

No

Can you swim?

Yes

No

Leadership

Are you/were you involved in any of the following organizations?

Eagle Scout

JROTC

Student Organization

Which Student Organization(s)?

Did you hold a position of responsibility/leadership in the student organization(s)?

How many years were you involved in JROTC?

Please list any other leadership experience (e.g. employment, church, etc.)

Additional Information: