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THE
ARMY RESERVE OFFICERS' TRAINING CORPS (ROTC)
TWO-YEAR
NON-SCHOLARSHIP PROGRAM FOR
ACTIVE DUTY ARMY ENLISTED PERSONNEL
**IMPORTANT-PLEASE
READ**
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
rotcroo@uccs.edu .
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
APPLICATION
PROCEDURES
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-scholarship
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: rotcroo@uccs.edu
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.
Back
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List of Green to Gold Points of Contact
|
Post
|
ROTC
Battalion
|
Comm
Telephone
|
DSN
Telephone
|
|
Aberdeen
Proving
|
Morgan
State Univ
|
(443)
885-3263
|
|
|
Alaska
|
Univ
Of Alaska
|
(907)
474-7501
|
|
|
APO
AP
|
HQ,
4th ROTC Region
|
(206)
967-3116
|
357-3116
|
|
APO-AA
|
HQ,
1st ROTC Region
|
(910)
396-7517
|
236-7517
|
|
APO-AE
|
HQ,
1st ROTC Region
|
(910)
396-7517
|
236-7517
|
|
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
|
236-7517
|
|
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
|
357-3116
|
|
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
|
(757)788-4571/3770
|
680-4571/3770
|
|
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
|
|
|
Hawaii
|
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
|
|
Back
to Top
INSTRUCTIONS FOR COMPLETING ROTC
CADET COMMAND FORM 173-R
U.S. ARMY ROTC GREEN TO GOLD
2-YEAR
NON-SCHOLARSHIP APPLICATION
To
be completed by applicant
|
ITEM
|
REMARKS
|
|
1.
Social Security Number
|
Self-explanatory
|
|
2.
Name, Scholarship Applicant
|
Self-explanatory
|
|
3.
Date of Birth
|
Enter
YEAR, MONTH and DAY
|
|
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 Aptitude
Area Score (GT)
|
Self-explanatory
|
|
17.
Army Physical Fitness Test
|
Enter raw scores for each event:
|
|
(APFT)
|
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
|
|
APFT SUM
|
Calculate APFT events for a total APFT
sum.
|
|
APFT PASS
|
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 Security
Clearance Completed
|
Enter
: Y = Yes N
= No
|
|
Type
Background Investigation
|
Enter
type ENTNAC, NAC, etc
|
|
20.
College or University
you will attend
|
Self-explanatory
|
|
21.
School Code
|
To
be completed by Army ROTC Program
|
|
22.
College or University you will attend for ROTC
|
Self-explanatory
|
|
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
|
Self-explanatory
|
|
31.
Verification and Signature by the MILPO and Date
|
Data
verified by Enlisted Records Section
|
|
32.
Applicant's Personal
Statement--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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