Forms

Forms for Enrollment Only

The seven documents listed below must be completed if the student wants to partake in the extra curricula activities associated with ROTC, such as: Physical fitness training, leadership labs, and Field Training Exercise (FTX) which include rifle ranges, land navigation training, obstacle courses, and leader reaction courses.

1.  Proof of Citizenship – Students must provide official documentation demonstrating that they are a citizen of the United States.  This can be completed by producing either a U.S. Birth Certificate or unexpired U.S. Passport.

2.  Social Security Card – Students must provide official document for verification by ROTC Cadre.

3.  CC 139-R – (Right click and “Save As”) This is a cadet enrollment record form. This form is fillable, DO NOT hand-write your information on this form. The form has 6 pages; however, only the first 2 pages need to be completed for contracting purposes. The following is a list of items that may help you when filling out the form:

  • Block # 9: DOB – Date of Birth
  • Block # 10: POB – Place of Birth
  • Block # 24: Next of Kin – Who would we contact in an emergency
  • Block # 25a / 26a: FICE code – Do not fill this in
  • Page #2: Initial one box in each section (blocks #42-46).
  • You must sign page #2 where is states “All information given on this form is correct to the best of my knowledge.”

4.  CC 137 – Authorization for access to student records.

  • Fill out part 1 if you would want to authorize an ROTC instructor to speak with your parents about your performance, to include grades, should they contact us.
  • Fill out part 2 if you do not want us to discuss your performance with your parents/legal guardian.

5.  CC 136 – Government Sponsored Benefits for ROTC Cadets.  Sign and date the bottom of the form.  This indicates that you have read and understand the information on the form.

6.  DA form 3425-R – Medical fitness statement.  Go to your physician and have that physician fill out this form saying you have no medical conditions or physical impairments that may hinder your participation in ROTC.

7.  DD 2983 – Recruit/Trainee Prohibited Activities Acknowledgment. Complete blocks 1-9 only.

Forms for Contracting

Application Checklist – This is a checklist of every form needed in order to contract with the ROTC program.

CC 139-R – The cadet enrollment record form has 6 pages; however, only the first 2 pages need to be completed for contracting purposes. The following is a list of items that may help you when filling out the form:

  • Block # 9: DOB – Date of Birth
  • Block # 10: POB – Place of Birth
  • Block # 24: Next of Kin – Who would we contact in an emergency?
  • Block # 25a / 26a: FICE code – Do not fill this in
  • Page #2: Initial one box in each section (blocks #42-46) on the second tab.
  • You must sign page #2 where is states “All information given on this form is correct to the best of my knowledge.”

CC 136 – Government Sponsored Benefits for ROTC Cadets. Sign and date the bottom of the form. This indicates that you have read and understand the information on the form.

CC 137 – Authorization for access to student records.

DD 2983 – Recruit/Trainee Prohibited Activities Acknowledgment. Complete blocks 1-9 only.

CC 104-R – This form is an academic plan worksheet. It should contain all of the classes you need to complete your bachelor’s degree, as well as, all of the required ROTC classes. You ROTC instructor will advise you on the best method for getting this document completed. It will require a signature from your academic advisor on page two, block #12.  

CC 104R Video Instructions

Dental Form – Need to know the location of your dental x-rays – for emergency purposes only. You are the person that signs this form. ***Do not bring your dental x-rays.

DD 93 – This is a Record of emergency data. Fill out the first two pages; if you need any instruction for how to fill out any part of these forms pages 3 and 4 contain instruction.

SGLI – The Service members’ Group Life Insurance Election and Certificate. Only need page two filled out. The additional forms are provided to ensure you understand the purpose and how to complete the form. Fill out your personal information at the top of page 2, elect if you want the life insurance, or want to reduce the amount, and list beneficiaries. Sign and date the bottom of the form.

SF 1199A – Direct Deposit form needs to be filled out and turned in in-order to receive direct deposits. You only need to fill out and print page one.

  • Section 1 (A, D, & E): completed by the Cadet and must sign first signature block in that section.
  • Section 3: Completed by the students bank official. Must have bank official’s signature; only exception is if you bank with USAA in Texas.

W4 – Tax form (with holdings: current year)

DD Form 2058 – State of Legal Residency Form. Fill in name, SSN, and your legal mailing address. Sign and date the bottom

  • Fill out part 1 if you would want to authorize an ROTC instructor to speak with your parents about your performance, to include grades, should they contact us.
  • Fill out part 2 if you do not want us to discuss your performance with your parents/legal guardian.

DA form 3425-R – Medical fitness statement. Go to your physician and have that physician fill out this form stating you have no medical conditions or physical impairments that may hinder your participation in ROTC.

DD Form 2005 – Privacy Statement for healthcare Records, Read form and sign and date the bottom.

SMP documents:

Meredith College Students

  • Meredith College students can enroll in Army ROTC by submitting a completed CRC Form to the Meredith College registrar’s office; and
  • Submitting the forms for ROTC Enrollment only to Mr. Johnson.
  • Contact Mr. Stephen Johnson at (919) 513-0863/smjohn18@ncsu.edu for information.

Wake Tech Students

  • Wake Tech students can enroll in Army ROTC by submitting a completed CRC Form to the Wake Tech registrar’s office; and
  • Submitting the forms for ROTC Enrollment only to Mr. Johnson
  • Information can be found at the Wake Tech ROTC page or by contacting Mr. Stephen Johnson at (919) 513-0863 or email smjohn18@ncsu.edu.

Cooperating Raleigh Colleges

About CRC

CRC Form