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| Home Phone |
Cell Phone |
What is the best way to contact you? |
| E-mail |
Age |
Date of Birth (dd/mm/yyyy) |
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Fall
Spring
Summer
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| Current School Year Level |
I plan to enter: |
Major |
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Next Semester (Fall or Spring)
Beginning Cumulative Credit Hours |
Current GPA (4.0 scale) |
Able to swim? |
| Extra-Curricular Activities (Sports and Clubs): |
| What is your goal once you graduate from College? |
| What specific questions do you have? |
| Would you like to schedule an office visit? |
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| If yes, please enter the date and time you would like to visit: |
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| How did you hear about the UCONN ROTC program? |
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| --SMP
AND PRIOR SERVICE ONLY-- |
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