Welcome to Arkansas State University!

ROTC Student Forms

On this page are all the forms that you need to enroll in the A-State Army ROTC Program. Click on a links to download the appropriate forms. The forms are in PDF (Adobe Acrobat Document) format which requires the free download of Adobe DC Reader located at this link: Adobe Acrobat 

Enrollment in freshman & sophomore classes does NOT require any commitment to Military Service.

Initial Cadet Paperwork (For enrollment into the Freshman or Sophomore ROTC Classes) * These forms need to be brought to the first class and turned into your instructor.  All forms are fillable and should be typed for submission. Handwritten forms will not be accepted due to potential errors from poor handwriting. Only signatures should be handwritten. 

Here you will find all the documents you need to participate in the Army ROTC program outside of the classroom setting. Please bring all your documents typed and signed to the first day of class and give them to your instructor or to the Enrollment and Scholarship Officer, Mr. David Hastings, prior to the start of semester classes. If you click on the document title below, it will open the form so you may type your information.

CC Form 136-R  Briefing on Government Sponsored Benefits. for ROTC Cadets  This document is required to inform students that in the event they are injured during a ROTC function, they may be covered by Workman's Compensation while receiving medical treatment.

CC Form 137-R  Authorization/Declination for Access to Student Records. This form gives/denies permission for parents/guardians access to student records held by the ROTC program. 

CC Form 139-R  Cadet Enrollment Record. The CC Form 139-R is NOT a contract that obligates the cadet to a career in the Army. It is the proper registration information that is required for the cadet to be "loaded" into the ROTC Cadet Command system. This way the cadet is covered if hurt during labs or other ROTC-related training. The information on the 139-R is also used to gather information for the cadet to contract and be eligible for benefits. ***Fill out ONLY the first two pages of this form. Print and bring to class all six pages. 

DA Form 3425-R  Fit to Train. This form will need to be taken to your family doctors office or to the Student Health clinic (~$35) to get a “sports physical.” You will not be reimbursed for this physical. Without a signature STAMP from the doctor or PA you will NOT be able to conduct any kind of physical training or Labs outside the classroom setting. PRIOR SERVICE CADETS: If you have a military MEPS physical from the USAR, Active duty, or the National Guard that is less than 1 year old, we can use the MEPS as a substitute for this Fit to Train form; bring all 8 pages with you (DD Forms 2807-1 and 2808).

Cadet Dental Form  Dental Point of Contact.  Information for your family dentist or the last place where your dental records were kept. If the only dentist that you have records with is a military dentist, please list your (National Guard or US Army Reserve) unit readiness NCO's contact information. 

The Next Step...for the truly committed!

Contracting Paperwork (Students accepting scholarships and/or dedicated Cadets who have decided to become an Officer)

These documents continue where the Initial Cadet Paperwork left off. The additional documents below are added to your current Student Personnel File. A contracted cadet has made the decision to complete the Military Science 3rd and 4th (Junior and Senior) years of our program and commission into one of the three components of the US Army; Active Army, Army National Guard or US Army Reserve as a Second Lieutenant. Cadets choosing to contract gain valuable leadership skills, training and financial benefits such as scholarships, monthly stipends, and book allowances each semester through graduation.

The following forms are set up in order to minimize delay toward contracting and maximize productivity:

CC Form 104-R  Planned Academic Worksheet CC Form 104-R.  This is probably the most important document that you will fill out as a Cadet. This form is a Cadet's Academic Plan to follow in order to graduate on time. Any ROTC Scholarship request is based off this form and date that you are scheduled to graduate.  Cadet Command Form 104-R must be fully typed and signed by the Academic Advisor, the Cadet, and the Professor of Military Science. It is a requirement for any cadet that enrolls in the program to complete. In the event the cadet contracts to become an officer, this document becomes an agreement between the university, the Army and the cadet for scholarship benefits and a commissioning timeline upon graduation.  This is not an actual binding contract for military service but a realistic predictor of academic requirements and graduation. The 104-R is only for graduation/commission purposes in the specified degree program.

DD Form 2492  DoDMERB Report of Medical History.   This form identifies historical medical issues for each cadet and is utilized in conjunction with scheduling a medical physical including hearing and vision paid for by the military at local clinic/clinics close to your university. A cadet must be medically qualified to serve in order to contract with the ROTC program. Obtaining a Qualified DoDMERB physical takes a month or more to complete so, it is imperative this action be completed toward the beginning of the process to minimize delay's.  

DD Form 369  Police Record Check   In order to qualify for contracting, a police background check must be conducted to ensure no "Non-waiver able" incidents have occurred that might impugn an Officer's ability to serve as a leader in the military. Felonies and Domestic abuse are incompatible with regulations that govern military service. Excessive ticketing for traffic violations and certain misdemeanors are waiverable.

DA Form 705  Army Physical Fitness Test Scorecard   The Army Physical Fitness Test consists of three events conducted in sequence with a minimum of ten minutes and no more than 20 minutes apart. The calculated score varies with the Gender and Age of the participants. This test is broken down into two minutes of push-ups, two minutes of sit-ups and a 2-mile run for time. The scoring requirements are listed in pages 3-6 of the attached form. 

National Guard SMP Form (Required on all National Guard Contracted Cadets)

NGB Form 594-1   Annex to DD Form 4 / DA Form 4836 - SMP Agreement ARNG. This form is utilized to place a National Guard Soldier who is contracting into an Officer Trainee position within a National Guard Unit. This form requires approval at 3 separate levels so, quick action on this form is critical for NG soldiers. Required for scholarship request.

CC Form 203-R   GRFD Scholarship Cadet Contract Endorsement  

USAR Forms (Required on all National Guard Contracted Cadets)

DA form 4824-R   Addendum to Certificate and Acknowledgement of Service Requirements for all US Army Reserve Personnel Applying for Participation in ROTC SMP. (Required for scholarship request)

USAR Unit Letter of Acceptance (LOA)  Addendum to DA Form 4824-R. (Required for scholarship request)

General information forms required

DD Form 93   Record of Emergency Data

DD Form 2005   Privacy Act Statement - Health Care Records

DD Form 2058   State of Legal Residence Certificate

SF 1199A   Direct Deposit Sign up Form ("Voided" Check attachment required)

SGLV 8286   Serviceman's Group Life Insurance Election and Certificate

W-4   Employee's Withholding Allowance Certificate

AR4EC  State of Arkansas Employee’s Withholding Exemption Certificate (Only used by Arkansas Residents) 

Other Forms You Must Provide to Contract

Proof of Citizenship - Birth Certificate, State Issued (or Naturalization Certificate, if applicable)

Social Security Card

Current Shot Records / MEDPROS Immunization Sheet

Official Transcripts from all High Schools and Colleges previously attended.

Blood Type, Hair Color, Eye Color, Religious Preference, and Army Enterprise E-mail address (if applicable)

The Final Step to Becoming a Contracted Cadet

These forms are for cadet information purposes only. When you reach this step, your cadre and administrative staff will have the appropriate documents listed below prepared for your review and signature. This link is provided for you to review the forms and submit any questions you may have prior to contracting. Signing these documents WILL constitute a contract with the U.S. Army.  

DD Form 4/1  Enlistment/Reenlistment Document for the Armed Forces of the United States AND

DA Form 597  Army Senior ROTC Non-Scholarship Contract OR

DA Form 597-3  Army Senior ROTC Scholarship Contract