Denotes required fields
First Name:
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Last Name:
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Year of Birth:
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Email:
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*
Phone:
Home City:
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Home State:
AE
Alabama
Alaska
AO
AP
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
N/A - Foreign Addresses
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
Saipan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
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Home Zip Code:
Prior Cadet:
Yes
No
Last Cadet Rank:
Year Left Program:
- Select Prior Cadet Rank -
E1/SR
E2/SA
E3/SN
E4/PO3
E5/PO2
E6/PO1
E7/CPO
- Select Year -
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
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Prior Adult Volunteer:
Yes
No
Last Adult Volunteer Rank:
Year Left Program:
- Select Prior Adult Rank -
MIDN
INST
WO
ENS
LTJG
LT
LCDR
- Select Year -
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
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Military Affiliation:
(click if affiliated)
Military Branch:
- Select Military Branch -
U.S. Marine Corps
U.S. Army
U.S. Navy
U.S. Air Force
U.S. Coast Guard
U.S. Space Force
Military Status:
- Select Military Status -
Active
Reserve
Inactive Reserve
Retired
Veteran
Military Pay Grade:
- Select Military Pay Grade -
O-10
O-9
O-8
O-7
O-6
O-5
O-4
O-3
O-2
O-1
W-5
W-4
W-3
W-2
W-1
E-9
E-8
E-7
E-6
E-5
E-4
E-3
E-2
E-1
Years of Service:
- Select Years of Service -
1 years
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
11 years
12 years
13 years
14 years
15 years
16 years
17 years
18 years
19 years
20 years
21 years
22 years
23 years
24 years
25 years
26 years
27 years
28 years
29 years
30 years
31 years
32 years
33 years
34 years
35 years
36 years
37 years
38 years
39 years
40 years
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What unit/s were you a member of:
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