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CADET ENROLLMENT RECORD |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Last Name
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | SSN
PART V - BASIC COURSE ENROLLMENT ELIGIBILITY CHECKLIST*
ALL NONCONTRACTED CADETS MUST MEET THE FOLLOWING CRITERIA TO ENROLL IN THE BASIC COURSE:
Enrollment Eligibility Officer:  Verify the criteria below and sign the certification on page 5.
49.  [NAME] |  |  |  |  |  |  | Eligible:  Registered for and attending full time (in accordance with university policy - usually 12 or more credit hours) a regular course of instruction resulting in an accredited undergraduate
 |  |  |  |  |  |  | or graduate degree at a host or partnership school.
 |  |  |  |  |  |  | Ineligible (Waiver denied):  Not registered for and attending full time a regular course of instruction at a host or partnership school.
50.  CONSCIENTIOUS OBJECTION |  |  |  |  |  |  | Eligible:  (a) U.S. Citizen and is not a conscientious objector.  (b) Enrolled alien student (exempt by statute).  (c) Students required by their school to take military training.
 |  |  |  |  |  |  | Ineligible:  Student is a U.S. Citizen and a conscientious objector at a school, which does not require its students to take military training. (NOTE: Prior to enrollment students who have
 |  |  |  |  |  |  | previously been conscientious objectors must furnish a letter stating they no longer have convictions that preclude bearing arms and participating in full military service with
 |  |  |  |  |  |  |  | the U.S. Army).
51.  CHARACTER |  |  |  |  |  |  | Eligible:  Good moral character.  No domestic violence conviction.
 |  |  |  |  |  |  | Ineligible:  Nonwaiverable.  Domestic violence misdemeanor or felony conviction.
52.  TATTOOS |  |  |  |  |  |  | Eligible:  Student does not have any tattoos specifically prohibited by Army policy (see ineligible below).
 |  |  |  |  |  |  | Ineligible:  (a) Any tattoo/brand on the face, neck or head (permanent facial makeup that conforms to AR 670-1 makeup standards is permitted).  (b)  Other tattoos/brands that are visible and
 |  |  |  |  |  |  |  | that detract from a soldierly appearance while wearing the Class A uniform.  (c)  Other tattoos/brands that are prejudicial to good order and discipline.
53.  CITIZENSHIP |  |  |  |  |  |  | Eligible:  U.S. Citizen (Must be verified per instructions).  (Dual citizens must renounce foreign citizenship prior to receiving a clearance (see CC PAM 145-4, 2-39a)).
 |  |  |  |  |  |  | Approval Required:  (a) Immigrant Alien  (b) Refugee (NOTE: Aliens are ineligible for scholarship and SMP, even if approved for enrollment).
 |  |  |  |  |  |  | Ineligible:  [NAME]. |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME]):         Date
54.  MEDICAL |  |  |  |  |  |  | Eligible:  DA Form 3425-R has been completed and signed by a qualified medical physician (or equivalent statement from university health care provider) showing no medical
 |  |  |  |  |  |  |  | condition/physical impairment that precludes enrollment in the basic course.
 |  |  |  |  |  |  | Ineligible (Waiver denied or nonwaiverable):  Qualified medical physician refuses to complete and sign DA Form 3425-R for the student.
* NOTE:  ENROLLMENT ELIGIBILITY OFFICER WILL CHECK THE INFORMATION IN PARTS I - III AND THE STUDENT'S STATEMENTS IN PART IV AND ADVISE THE STUDENT IF A
[NAME] IS REQUIRED PRIOR TO CONTRACTING I.E., AGE, RE-CODE, DEPENDENCY, CIVIL CONVICTION, SUBSTANCE ABUSE, ETC. (Waiver approval is not guaranteed).
PART VI - NONSCHOLARSHIP CONTRACTING ELIGIBILITY CHECKLIST
ALL NONSCHOLARSHIP CADETS MUST MEET THE FOLLOWING CRITERIA TO CONTRACT:
Enrollment Eligibility Officer:  Verify the criteria below and sign the certification on page 5.  (Scholarship students must also meet scholarship eligibility requirements in Part VII)
55.  PREVIOUS CRITERIA |  |  |  |  |  |  | Eligible:  Student meets criteria 49-54 on the Basic Course Enrollment Eligibility Checklist (Part V).
 |  |  |  |  |  |  | Waiver Required:  Pending waiver for criteria in Part V above. |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME]):             Date
 |  |  |  |  |  |  | Ineligible (Waiver denied or nonwaiverable).
56.  CIVIL CONVICTION |  |  |  |  |  |  | Eligible:  (a) No civil conviction, adverse adjudication, or court-martial conviction other than minor traffic violations (Exception: alcohol-related driving offenses) resulting in a fine
 |  |  |  |  |  |  |  | of less than $250.  (b) Not guilty verdict or successful appeal of a conviction.
 |  |  |  |  |  |  | Waiver Required (Prior to Contracting):  Any civil conviction, adverse adjudication, or court-martial conviction other than minor traffic violations (Exception: Alcohol-related driving offenses)
 |  |  |  |  |  |  |  | resulting in a fine of less than $250. Any conviction resulting in other adverse dispositions (punishment other than a fine) requires a waiver. Convictions where the record is
 |  |  |  |  |  |  |  | expunged, sealed, set aside, dismissed, or original finding or pleas changed still require a waiver.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME]):             Date
 |  |  |  |  |  |  | Ineligible (Waiver denied or nonwaiverable):  (a) Pending charges for violating any civil law;  (b) On supervised and/or conditional probation.
57. DEPENDENCY |  |  |  |  |  |  | Eligible:  (a) Single student with no dependents.  (b) Married student with no more than three (3) dependents, to include spouse.  (c) Single student whose children have been placed by
 |  |  |  |  |  |  |  | court order in the custody of an adult relative/legal guardian and the student is not required to pay child support.
 |  |  |  |  |  |  | Waiver Required (Prior to Contracting):  (a) More than three (3) dependents (spouse plus more than 2 children under 18 years old).  (b) Single parent whose children have been placed by
 |  |  |  |  |  |  |  | court order in the custody of an adult relative/legal guardian when the student is required to pay child support.  (c) Spouse is also in Army ROTC and there are children under
 |  |  |  |  |  |  |  | 18 years old.  (d) Spouse is in a military component of any Armed Service (other than Inactive Ready Reserve) when student has a child under 18 years old.
 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | [NAME]):             Date
 |  |  |  |  |  |  | Ineligible (Waiver denied or nonwaiverable):  Single parents who have legal custody of their children who are under 18 years old.
CC Form 139-R, DEC 2007 |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  | Page 3 of 6