1. Read through each line item

2. Answer "Yes" or "No" as it applies to #1 & #2 using a check mark or "x"

3. If you answered "Yes" to either #1 or #2, on a separate paper answer questions a through g, then sign and date that statement.

4. Read & Initial #3 using HANDWRITTEN initials. Typed initials will not be accepted

When initialing use ALL of your initials as they apply for example

John Doe (no middle name) use initials "JD"

John Jane Doe use initials "JJD"

John Jane Doe Smith use initials "JJDS"

5. Sign the form over "Signature of Applicant"

6. Type Last Name, First Name Middle Name

7. Witnessing Official will be the NROTC Coordinator or Navy Recruiter

8. Email to NROTC Coordinator or drop off at a local Navy Recruiting Office.

If you answered "Yes" to #1 or #2 please send through the DOD Safe File exchange site to protect your privacy or to a local Navy Recruiting Office.