Candidate Interest Form

1.

1. First Name:

First Name:

2. Last Name:

Last Name:

3. Date of Birth:

Date of Birth:

4. Age:

Age:

5. Sex:

Sex:

6. Race:

Race:

7. Citizenship:

Citizenship:

8. Address:

Address:

9. Phone Number where you can best be reached:

Phone Number where you can best be reached:

10. E-mail Address:

E-mail Address:

11. High School Attended, City, State:

High School Attended, City, State:

12. Height in inches:

Height in inches:

13. Weight in pounds:

Weight in pounds:

14. Are you in a Delayed Entry Program or currently Active Duty Military?

Are you in a Delayed Entry Program or currently Active Duty Military?

15. Have you ever ran 1.5 miles? If so, what was your time?

Have you ever ran 1.5 miles? If so, what was your time? Minutes
Seconds

16. Can you swim 50 yards without stopping?

Can you swim 50 yards without stopping? Yes

17. High School GPA:

High School GPA:

18. Class Rank (ex. 25 of 400):

Class Rank (ex. 25 of 400):

19. Graduation Date (MM/YYYY):

Graduation Date (MM/YYYY):

20. SAT/ACT Composite Score:

SAT/ACT Composite Score:

21. SAT/ACT Math:

SAT/ACT Math:

22. SAT/ACT Verbal:

SAT/ACT Verbal:

23. If you participated in JROTC, what what the highest billet you held?

If you participated in JROTC, what what the highest billet you held?

24. Please list any extracurricular activities you are involved in:

Please list any extracurricular activities you are involved in:

25. If you are enrolled in college what is your current GPA?

If you are enrolled in college what is your current GPA?

26. Please list the most advanced MATH and SCIENCE courses you completed in HIGH SCHOOL:

Please list the most advanced MATH and SCIENCE courses you completed in HIGH SCHOOL:

27. If you are enrolled in COLLEGE, please list the most advanced MATH and SCIENCE courses you have completed:

If you are enrolled in COLLEGE, please list the most advanced MATH and SCIENCE courses you have completed:

28. Which university are you interested in attending?

Which university are you interested in attending? Savannah State University

Armstrong Atlantic State University

29. Which branch of service are you interested in joining?

Which branch of service are you interested in joining?

30. Please list any medical issues that may prevent you from military service:

Please list any medical issues that may prevent you from military service: