Forms

CC Form 104-R

Please use the form for your respective school

• Bloomsburg University
• Bucknell University
• Susquehanna University

Other Enrollment Forms

• CC Form 139-R: Cadet Enrollment Record
• CC Form 137-R: Release of Student Records
• DA Form 3425-R: Medical Fitness Statement
• DD Form 2983-R: Recruit/Trainee Prohibited Activities Acknowledgement

Contracting Forms

The following documents are for informational purposes only. These contracts will be prepared by the ROTC office, however the information will be the same. They include the benefits and obligations of all contracted cadets.

• DA Form 597: Cadet Non-Scholarship Contract. Non-scholarship cadets need to read this thoroughly prior to contracting.
• DA Form 597-3: Cadet Scholarship Contract. Scholarship cadets need to read this thoroughly prior to contracting.
• DD Form 4: Enlistment Document. All contracting cadets need to read this thoroughly.
• DA Form 4824-R: Simultaneous membership program agreement for Army reservists. This must be submitted to us if you elect to do the simultaneous membership program with the U.S. Army Reserves.
• NGB 594-1: Simultaneous membership program agreement for Army National Guard cadets. This must be submitted to us if you elect to do the SMP program with the National Guard.
• CC Form 203-R: Guaranteed Reserve Forces Duty Scholarship Cadet Contract Endorsement
• CC Form 136-R: Briefing of Government Benefits
• DD Form 2005: Privacy Act Statement, Health Care Record
• SF1199A: Direct Deposit Form
• DD 2058: State of Legal Residence
• DD 368: Police Check
• DD 93: Record of Emergency Data
• SGLV 8286: Soldier’s Group Life Insurance Form
• W4 found online
• APFT Card kept on file by instructor
• PSIP draft sent by HRA
• Submit* a copy of your Birth Certificate, Drivers License and SSN Card

*For more guidance or to submit forms speak to the Bison HRA, Ms. Cathy Akers, or speak with your assigned instructor.