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This application is for attendance at the University of Colorado at Colorado Springs (UCCS) or one of UCCS' partnership schools.  If you are interested in taking part in the Army ROTC Non-Scholarship Program at a different school you must contact that school for an application.  You may use this application as a reference applications to other institutions.

It is your responsibility to ensure that your application is complete and returned to:

University of Colorado at Colorado Springs, C/O Department of Military Science, ATTN: Recruiting Operations Officer, 1420 Austin Bluffs Parkway, Colorado Springs, CO 80918.

Deadlines: Your application must be complete and received no later than eight weeks prior to the start of the semester you begin your studies.  It is in your best interests to submit your application as early as possible.

If you change your address after you submit your application please notify the University of Colorado at Colorado Springs, C/O Department of Military Science, ATTN: Recruiting Operations Officer, 1420 Austin Bluffs Parkway, Colorado Springs, CO 80918 in writing or via E-Mail at .

Application Procedures
List of Green to Gold Program Points of Contact
Green to Gold Non-Scholarship Checklist
Instructions for Application
List of Approved Academic Disciplines
Green to Gold Non-Scholarship Application
Applicant Snapshot
DoDMERB  DD Form 2351

DoDMERB  DD Form 2492
Training Service Obligation Worksheet
Sample DA Form 4187 - Time-in-Service
Sample DA Form 4187 - Service Obligation
Statement of Understanding (Dependency)
Financial Statement


Read instructions carefully.  Print or type the information required.  Incomplete or inaccurate forms may eliminate you from consideration.  It is your responsibility to ensure that all required forms are submitted to University of Colorado at Colorado Springs, C/O Department of Military Science, ATTN: Recruiting Operations Officer, 1420 Austin Bluffs Parkway, Colorado Springs, CO 80918 and RECEIVED NOT LATER 60 DAYS PRIOR TO COMMENCEMENT OF EDUCATION. Incomplete docs will not be considered for the Non-Scholarship Program.  NOTE:  RETAIN A COPY OF ALL PAPERWORK FORWARDED FOR YOUR RECORDS.

Your completed application will consist of the following:  (NOTE:  See Checklist)

a.  Cadet Command Form 173-R (Application for U.S. Army ROTC Green to Gold 4-, 3-, and 2-Year Scholarship).  If your answer to Item 18, civil conviction is yes YOU MUST REQUEST A WAIVER OF THE DISQUALIFICATION.  The waiver request must be submitted with your application.  Include a complete written description of the offense, to include all circumstances leading up to arrest and conviction and complete sentence imposed, copy of the court record which indicated the charge, plea, and/or findings, as well as the sentence imposed and the record showing satisfaction of the sentence (when court records are not available this fact must be established by correspondence from the court), and three recent letters of character reference which indicate that the writer is aware of your specific situation requiring a waiver.  Your statement must be certified under oath.  If an offense occurs after you submit your application up to the date of discharge you must also inform this headquarters and request a waiver.

b.  Cadet Command Form 173-R (continued).  A favorable recommendation from your commanding officer and field grade commander commenting on your officer-like qualifications, i.e., leadership potential, appearance, personality, military record and aptitude for further military training.

c.  Cadet Command Form 103-R (Active Duty/Reserve ROTC Scholarship Applicant Snapshot).  Affix a recent (within the last 3 months) photograph, which will be retained by this headquarters.  A full-length photograph in uniform is requested.  Print your name and social security number on the back of the snapshot or photograph and on the form.

d.  A copy of APFT scorecard (DA Form 705) (must be within the last 6 months)

e.  A current up to date copy of your Personnel Qualification Record, Enlisted Records Brief.

f.  Medical Examination. If you have had a medical examination and it is less than 24 months old  you may submit that DD Form 2807, or DD Form 2808 (MEPS/MTF) to DoDMERB requesting an upgrade via the remedial route to a DoDMERB equivalent exam. DoDMERB will probably identify several remedials such as a new eye exam and several history questions not present on a MEPS/MTF exam for completion by the applicant. A MEPS/MTF exam is not equivalent to a DoDMERB exam unless it has been upgraded first by DoDMERB via the remedial route. If no previous medical is available, please have your Commanding Officer/First Sergeant contact the Physical Exam section of TMC# 10, Fort Carson, CO and request they accomplish a physical IAW AR 40-29.  The following medical forms must be used.  When completing DD Form 2351, enter FICE: 004509 in block 8. If you are submitting a previous DD Form 2808, correct block 13 (Organization Unit and UIC Code) to read  FICE: 004509 .  If any additional tests or evaluations are required for final medical determination, DODMERB will return the packet to you at your unit of assignment.  DODMERB will return the completed physical back to this headquarters. You must be fully medically qualified for scholarship PRIOR to discharge.  Medical examinations must be submitted at the time of application to this headquarters.  This headquarters will forward the physical to DODMERB with the appropriate form for processing as an Army ROTC scholarship applicant.  DO NOT SEND THE PHYSICAL YOURSELF TO DODMERB.  Delay in forwarding physical could result in not being medically qualified in sufficient time to be released from the Army for enrollment.  The physical qualification process normally takes DODMERB anywhere from 6-8 weeks from start to finish.  Any remedials or follow-up required by DODMERB should be accomplished by you prior to announcement of acceptance.

g.  Official transcripts of all colleges you have attended.  The Professor of Military Science will not consider application docs with partial transcripts.  The school accepting you for attendance should establish a grade point average (GPA).  However, if GPA is not established by the school then the GPA from your latest complete transcript will be used.  If you have received college credit by means of the USAFI or CLEP tests, official results of such tests must also be furnished to this headquarters. College Grade Reports are not transcripts and are unacceptable.

h.  Letter of acceptance from a baccalaureate degree producing college or university offering Army ROTC indicating your status as an academic junior.  If you are undergoing academic studies and have not attained junior status at the time of application to a school, the letter may state that you are conditionally accepted pending final completion of current studies.  A follow-up letter and Cadet Command Form 104-R indicating your status will be required prior to you receiving your letter of acceptance.

i.  Letter from the Professor of Military Science (PMS) acknowledging contact has been made and they are aware of your pending enrollment in their program.

j.  Planned Academic Program Worksheet (ROTC Cadet Command Form 104-R.  The enclosed form indicating your academic status must be completed by the university's advising department or departmental head.  (Example:  If your intended major is Nursing, the 104-R must be from the School of Nursing.)  The Professor of Military Science will assist you in the completion of this form.  Verification form must indicate you have been accepted in the academic discipline that you indicate you will pursue.  Non-s cholarship recipients must attend the institution that provides the Form 104-R. Applicants who desire to attend a school other than the one which provided the initial 104-R must submit a subsequent 104-R verifying your academic status, letter of acceptance from the college/university prior to discharge. This form must be signed and authenticated by the student and the registrar.  Changing of schools between discharge and contracting will not be authorized.  Cadet Command Form 104-R containing summer sessions will not be accepted.

k.  Evaluation of Transfer of Credit.  If you will be attending a college/university other than the one from which you obtained your college credits, an evaluation of transfer of credits is required.  Evaluation should include course number and title, course grade, credit hours attempted and earned toward the degree pursuing and grade point average if available. (NOTE:  Some university systems may accept transfer credit for placement purposes and still require additional evaluation by the department awarding the degree. This may change your academic status)

l. Memorandum For Record describing your Student Athlete Leader (SAL) attributes as outlined in the Eligibility section.

m. Copy of waiver request (dependency, civil convictions, etc) if applicable.

n. CC Form 132-R.  Statement of Understanding (Dependency)

o. CC Form 228-R.  Financial Statement


Should you have questions or desire assistance in completing your scholarship application, you may contact the University of Colorado at Colorado Springs Army ROTC at: or 719.255.3475 or a unit located near your installation.  These units are listed in the  Green to Gold Points of Contact.  If you are stationed at a site outside the Continental United States, your local education center may provide assistance in completing your scholarship application.  If you have questions that cannot be answered through your education center, you may call a  Green to Gold Points of Contact.

NOTE:  Should you have any change in status (address, dependency, marital status, civil conviction, pregnancy, etc.) from the time you apply for a scholarship until notification of awards and discharge, you must inform this headquarters.

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List of Green to Gold Points of Contact



ROTC Battalion

Comm Telephone

DSN Telephone

Aberdeen Proving

Morgan State Univ

(443) 885-3263



Univ Of Alaska

(907) 474-7501



HQ, 4th ROTC Region

(206) 967-3116



HQ, 1st ROTC Region

(910) 396-7517



HQ, 1st ROTC Region

(910) 396-7517


Ft Belvoir, Va

George Mason University

(703) 993-2706


Ft Benning, Ga

Columbus State

(706) 568-2058


Ft Bliss, Tx

Univ Of Texas At El Paso

(915) 747-5621


Ft Bragg, NC

HQ, 1st ROTC Region

(910) 396-7517


Ft Buchanan, Pr

U/Puerto Rico-Rio Piedras

(787) 764-0000x7655


Ft Campbell, Ky

Austin Peay State Univ

(931) 221-6149/6155


Ft Carson, Co

U of Co at Colorado Springs

(719) 255-3236


Ft Dix, Nj

Princeton Univ

(609) 258-4225


Ft Drum, Ny

Syracuse Univ

(315) 443-1752


Ft Eustis, Va

College of William & Mary

(757) 221-3600


Ft Gordon, Ga

Augusta State Univ

(706) 737-1643


Ft Hood, Tx

Tarleton State University

(254) 968-9188


Ft Huachuca, Az

University Of Arizona

(520) 621-9822


Fort Irwin, CA

Claremont McKenna College

(909) 621-8102


Ft Jackson, Sc

Univ Of South Carolina

(803) 777-6542


Ft Knox, KY

University of Louisville

(502) 852-7902


Ft Leavenworth, Ks

University Of Kansas

(913) 864-3311


Ft Lee, Va

Virginia State Univ

(804) 524-5216


Ft Leonard Wood,

4th Brigade Headquarters

(573) 596-0276


Ft Lewis,, WA

HQ, 4th ROTC Region

(206) 967-3116


Ft Rucker, Al

Auburn University

(334) 244-3528


Ft Mcpherson, Ga

Georgia Inst Of Tech

(404) 894-4760


Ft Meade, Md

Bowie State

(301) 860-3560


Ft Monmouth, NJ

Rutgers Univ

(732) 932-7311


Ft Monroe, Va

HQ, Cadet Command



Ft Myer, Va& WRAH

Georgetown Univ

(202) 687-7056


Ft Polk, La

Northwestern Louisiana State

(318) 357-5156


Ft Riley, Ks

Kansas State Univ

(785) 532-6754


Ft Detrick, Md

Western Maryland College

(410) 876-3804


Ft Sam Houston, Tx

Univ of Tx At San  Antonio

(210) 458-4622


Ft Sill, Ok

Cameron University

(580) 581-2340


Ft Stewart, Ga

Georgia Southern Univ

(912) 681-5320



University of Hawaii

(808) 946-2849


Redstone Arsenal

Alabama A&M

(256) 858-4030


Walter Reed Army

Georgetown Univ

(202) 687-7056


White Sands Mr, Nm

New Mexico State Univ

(505) 646-4030


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To be completed by applicant



1.  Social Security Number


2.  Name, Scholarship Applicant


3.  Date of Birth


4.  Sex

Enter M (male) or F (female)

5.  Race

Indicate your Racial/Ethnic Descent


A   Asian or Pacific Islander


C   White, not Hispanic


H   Hispanic


N   Black, not Hispanic


T   American Indian or Alaskan Native


X   Other/Unknown

6  Home Address

Provide complete address

7. Work Address

Provide complete unit address

8. Telephone Numbers

Self-explanatory - If overseas provide Commercial number

9. Marital Status

Enter appropriate code:


S = Single


M = Married


D = Divorce


P = Separated

10. Number of Dependents

The number entered must  include spouse and children   (Do not count yourself)

11. Spouse Military

Is spouse is a member of any Armed Services enter


Y = Yes


N = No

12. Source of Citizenship

Enter code


B = Citizen by birth


N = Naturalized Citizen


P = Pending

Naturalization Number

Enter naturalization number  in space provided

13. Rank

Enter your current rank.

14. Enlistment Data

Self-explanatory-Ensure the Date of Enlistment is your Basic Service Entry Date

15. MOS

Enter first three digits of your primary MOS

16. General Technical AptitudeArea Score (GT)


17. Army Physical Fitness Test

Enter raw scores for each event:


a. PUSH UPS:  Enter exact number of repetitions.


b. SIT UPS: Enter exact number of repetitions


c. 2-MILE RUN: Enter exact time in minutes and seconds


Calculate APFT events for a total APFT sum.


Enter: Y = PASSED or N = FAILED

18. Civil Conviction

Indicate if you have been arrested, indicted, or  convicted of violating a civil or military law or had an adverse juvenile adjudication or other adverse disposition imposed except minor traffic violations for which a fine of $250.00 or less was imposed


Enter:  Y = Yes; N = NO

19. Favorable SecurityClearance Completed

Enter : Y = Yes  N = No

Type Background Investigation

Enter type ENTNAC, NAC, etc

20. College or University  you will attend


21. School Code

To be completed by Army ROTC Program

22. College or University you will attend for ROTC


23. School Code

To be completed by Army ROTC Program

24. Resident Student Status

Indicate in-state or out-of- state tuition rate which you will qualify


R = Resident Student (Instate)


N = Non-Resident Student(Out of State)

25. Academic Major

Enter the appropriate code for  the academic discipline you will pursue.

26. Scholarship Type

Enter the appropriate code for the type of scholarship applying for:


2 = 2-Year       M= Master

27. Awards, Decorations, etc.

List awards, decorations or special recognition bestowed upon you.

28.  Email Address of Applicant

Personal or Official  (Mandatory)

29. Fax number for Applicant

DSN or Commercial

30.  Signature of Applicant and Date


31. Verification and Signature by the MILPO and Date

Data verified by Enlisted Records Section

32. Applicant's PersonalStatement--Must be completed

Requires a written or typed statement why you desire a commission as an Army officer

33. Completed by Commanding Officer

Self-explanatory - include Rank

34. Completed by Field Grade Commander

Self-explanatory - provide address if different from soldier's work address.

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