Personal Information
*
First Name:
Required.
Middle Initial:
*
Last Name:
Required.
Suffix:
JR
SR
I
II
III
IV
*
Date of Birth:
Month
JAN
FEB
MAR
APR
MAY
JUNE
JULY
AUG
SEPT
OCT
NOV
DEC
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
*
Gender:
Male
Female
Please make a selection.
Current Address
*
Street Address:
Required.
Street Address 2:
*
City:
Required.
*
State:
Select One
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
D.C.
Florida
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Hawaii
Idaho
Illinois
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Pennsylvania
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South Carolina
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Tennessee
Texas
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Vermont
Virginia
Washington
West Virginia
Wisconsin
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American Samoa
Federated States of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Trust Territory of the Pacific Islands (Palau)
Puerto Rico
US Minor Outlying Islands
Virgin Island
Armed Forces Americas
Armed Forces Europe, Middle East, and Canada
Armed Forces Pacific
Please select state.
*
ZIP Code:
Required.
Invalid format.
Contact Information
Area Code:
Invalid format.
Phone Number:
Invalid format.
eg. 555-5445
Type of Phone:
Home
Work
Mobile
Best Time to Call:
Morning
Afternoon
Evening
May we contact
you via E-Mail?
Yes
E-mail Address:
Invalid format.
Opt in for future communications
from the U.S. Army. Privacy Policy
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Either phone or email is required
Education
Are you currently enrolled in school?
Yes
No
What is the highest grade you have completed?
High School:
9
10
11
12
College:
1
2
3
4
more than 4