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CADET ENROLLMENT RECORD |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Last Name
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | SSN
PART IV - STUDENT STATEMENTS
42.  RELEASE OF INFORMATION
The Privacy Act requires that we notify you of other routine uses of the information we collect from you. You should know that if you leave school, we might provide your name, address, and phone number to the U.S. Army
Recruiting Command. This is done because the Active Army, Army Reserve, and National Guard want and need intelligent young men and women. They also have programs which might help you return to college. The
transfer of information to the Recruiting Command means that, if you drop from school, you may receive information in the mail or be called by an Army Recruiter. You are under no obligation to accept the mail or to talk to the
recruiter.
 |  | I have read and understand the above statement concerning data required by the Privacy Act of 1974.
Verification of the following statements is required in order to assist in establishing eligibility to participate in the [NAME] program. Failure to provide a response will preclude further processing as an enrolled cadet. Failure to provide
an accurate or truthful response is grounds for barring entry into the SROTC program or for the initiation of disenrollment action. Your signature at the bottom of this page will attest to the accuracy of your responses on this form.
43.  STATEMENT OF CRIMINAL PROCEEDINGS BY CIVIL OR MILITARY AUTHORITIES
I have not been indicted or summoned into court under civilian or military law as a defendant in a criminal proceeding, to include any and all proceedings involving juvenile or adult criminal offenses,  but excluding minor traffic
violations (Exception:  alcohol-related driving offenses) which involved a fine or forfeiture, alone, of less than $250. I have not had 6 or more minor traffic violations (excluding parking violations) in a 12-month period where the fine is
$100 or more per offense. I have not had 12 or more minor traffic violations (excluding parking violations) during the previous 3 years where the fine is $100 or more per offense. I have never been convicted, fined, imprisoned,
placed on probation, paroled, or pardoned (to include alcohol violations and misdemeanors), except for minor traffic violations as defined above. I will advise the Professor of Military Science of any future information pertaining to
any changes of criminal conduct against myself and I shall do so as soon as practical under the circumstances. Records that are expunged, sealed, set aside, dismissed, or original findings or pleas changed STILL require a waiver.
Check One:
 |  | The above statement is true. |  |  |  |  |  |  | The above statement is not true - Explain:
44. SUBSTANCE ABUSE
Check One: |  |  |  |  |  | I have never used an illegal substance or drug.
 |  |  |  |  |  | I have used illegal substances or drugs only on an experimental or limited basis. |  |  |  |  |  |  |  |  |  |  |  |  | When: |  |  |  |  |  |  |  |  |  |  | How Often:
 |  |  |  |  |  | I have been a recent or frequent user of illegal substances or drugs. |  |  |  |  |  |  |  |  |  |  |  |  | When: |  |  |  |  |  |  |  |  |  |  | How Often:
NOTE:  Any future drug use will be grounds for disenrollment from the ROTC Program.
45.  RELIGIOUS ACCOMMODATION
The U.S. Army cannot guarantee that my religious practices will be accommodated. I acknowledge and understand that it is the Department of the Army's policy to accommodate religious practices as long as the practice will
not have an adverse impact on military readiness, unit cohesion, standards, health, safety or discipline. I further acknowledge and understand that the U.S. Army has the right to amend or eliminate any such accommodation
based on the needs of the Army.
 |  | I have read and understand the above statement concerning accommodation of my religious practices.
46.  CONSCIENTIOUS OBJECTION
If you have moral convictions that preclude you from bearing firearms and/or participating in full military service with the U.S. Army, to include armed combat, then you are a conscientious objector. AR 600-43 defines
conscientious objection as "A firm, fixed and sincere objection to participation in war in any form or the bearing of arms, because of religious training and belief."
Check One: |  |  |  |  | I am not a conscientious objector. |  |  |  |  |  |  |  | I am a conscientious objector. |  |  |  |  | Explain:
47.  DOD HOMOSEXUAL CONDUCT POLICY BRIEFING
Although you have not been asked nor will you be asked about your sexual orientation, you should be aware of the DoD Homosexual Conduct Policy. Homosexual conduct is grounds for barring entry or continued enrollment in the
SROTC Program. Homosexual conduct is a homosexual act, a statement that demonstrates a propensity or intent to engage in homosexual acts, or a homosexual marriage or attempted marriage. A homosexual act means any
bodily contact, actively undertaken or passively permitted, between members of the same sex for the purpose of satisfying sexual desires and any bodily contact that a reasonable person would understand to demonstrate a
propensity or intent to engage in such an act.
I understand I will be disenrolled from the SROTC Program if one or more of the following findings is made:
a.  I have engaged in, have attempted to engage in, or have solicited another to engage in homosexual act or acts.
b.  I have made a statement that demonstrates a propensity or intent to engage in homosexual acts.
c.  I have married or attempted to marry a person of the same sex as myself.
FOR ENROLLMENT OFFICER USE: |  |  |  |  |  |  | Ask the following questions to ensure the applicant understands this policy and expand on the policy, as necessary:  (1) Do you fully understand the DoD Homosexual
Conduct Policy briefing you have read?  (2)  Do you have any questions concerning this policy?
 |  | I have read and understand the briefing concerning the DoD Homosexual Conduct Policy.
"All information given on this form is correct to the best of my knowledge." |  |  |  |  |  |  |  |  |  |  |  |  | SIGNATURE OF CADET
48.  LOYALTY OATH (OPTIONAL FOR NONCONTRACTED CADETS)
" I do solemnly swear (or affirm) that I will support and defend the Constitution of the United States of America against all enemies, both foreign and domestic; that I will bear true faith and allegiance to the same, and that I take
this obligation freely, without any mental reservation or purpose of evasion, so help me God."
SIGNATURE OF CADET |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | DATE
CC Form 139-R, DEC 2007 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Page 2 of 6