Large 30 Page Application

APPLICATION FOR MARINE CORPS OFFICER PROGRAMS

MARINE CORPS OFFICER SELECTION OFFICE 2025 Guadalupe St., Suite 136 Austin, TX 78705 (512) 477-5706/5707

APPLICATION PACKET INSTRUCTIONS Enclosure 1: Rough Application for Marine Officer Programs Read all instructions carefully. Handwrite legibly in black ink. Most of the forms are self-explanatory, however, some additional guidance is required to ensure they are completed correctly and completely. All non-applicable areas should be marked as such. Ensure you read the all of the below before completing the forms. Contact the Officer Selection Team with any questions.

Enclosure 4: Level of Activity Statement Answer all questions, print name, and sign. Do not put a date on this document.

Enclosure 5: Statement of Understanding Regarding Dental Requirements Prior to Attending OCS Read and sign on the applicant signature line. Do not put a date on this document. The OSO/OSA will fill out the “witnessed by” line.

Enclosure 6: Privacy Act Statement- Health Care Records Sign in the Signature of patient block and provide your SSN. Do not date this document. *The government requires this document. It is needed for the purpose of documenting medical provisions and care provided in view of future rights and benefits.

Enclosure 7: Academic Certification For Marine Corps Programs Fill out “name of student”, “social security number” and “college/university”. On the backside of this document; sign the “signature of applicant” line, and date. Once you’ve filled this document out you must take this to your college registrar. They will fill it out or provide you with their school’s computer generated equivalent on the spot. Bring both of these back with you.

Enclosure 8a: Reference Questionnaire-Dean Fill out “signature of applicant”, “date” and the Box with “name”, “social security number”, and “address” on the REVERSE side of this document. This is a reference form designed for a college Dean to fill out. The Dean (or his office) simply needs to circle the “has” or “has not” and sign the bottom of this page. Take this form to the University’s “Dean of Students” office. Not the Dean of your individual college (i.e. engineering, education, communication, etc.) We understand the Dean of Students does not know you personally, but their office can verify if you have been on disciplinary probation while attending that school. **University of Texas students: The Dean of Students office will not fill out this document; take this to them anyway, they will be familiar with this. They will print you a Dean letter exactly like enclosure 8b (see next enclosure) that will suffice for our office.

Enclosure 8b: Example of UT Dean letter This is the letter format you will receive from the Dean of Students at the University of Texas. This is included for you to show the Dean’s office what it is you need. They will produce this for you on the spot.

Enclosure 9: Reference Questionnaire Make 4 copies of this enclosure. Fill out the box of information on the REVERSE side of each copy. This is your references’ format. You are required to have at least one professor, one employer, and two others (family friends, more employers, more professors, co-workers, etc.) You will have a total of 4 references (you may have more if you would like, 4 is the minimum). Instruct your reference to fill out the evaluation by answering the appropriate box next to questions 1-16; write at least 2 sentences under general comments; and fill out the information at the bottom of the page. They have the option of writing a more robust reference letter; however, they need to still fill out questions 1-16 and simply write “see attached” under general comments. **Note: This is where most applications become very bogged down and never make it too selection. It is suggested that you get your minimum 4 references quickly by choosing people you can see face to face and have them fill this out in 10 minutes and return to you quickly. You can make additional copies and mail them to references you desire that are not in close proximity, instruct them to mail it back to our office with the address on the letter head on the reverse side. Our office can provide you with pre-addressed and prestamped envelopes to send along with this form, simply stop by the office to get these.

Addendum 1: Medical History Questionnaire Simply check “yes” or “no” to each of the 75-questions. Follow the instructions at the top of the sheet. If you answer, “yes” to a question you must find medical documents pertaining to that medical issue. In the event you cannot find medical documents, you must write a ‘standard format’ letter to “To whom it may concern” stating the what, when, where, how, current status of the issue, and the reason medical documentation could not be attained. ***This is the stumbling block for most applicants; pursue and locate your medical history documents quickly and proactively, if you cannot find them draft the letter in a timely fashion and submit with your rough application.

Addendum 2: Employment History Follow the instructions on the top of the form.

MARINE OFFICER PROGRAMS ROUGH APPLICATION Congratulations on your decision to pursue an application for the Marine Officer Programs! The timely submission of this rough application is the single best indicator of your genuine interest to pursue a commission as a Marine Corps Officer. A significant delay in the receipt of this application can only be interpreted as a loss of commitment on your part. This Program is very competitive and the number of openings available per category is limited; consequently, it is in your best interest to pursue the application process aggressively. If for some reason you are unable to complete the document by the date listed below, please call to let us know when you will have it completed by. The Officer Selection Team is here to facilitate the timely submission of your application and assist you through the process. From the time you make the decision to apply, we will provide the guidance necessary to enable you to complete the entire application process in time for submission to the Selection Board. APPLICATION REQUIREMENTS The Officer Selection Team will identify the specific requirements from the following list that are applicable to your situation and the Program for which you are applying. ALL Applicants  Statement of Understanding (Attached)  Rough Application (Attached)  Academic Certification Form (Attached)  Dean Letter (Attached)  Copy of Birth Certificate (we can true copy in the office)  Copy of Social Security Card (we can true copy in the office)  Transcripts Prior Military Applicants  Copy of DD214 (Prior Service Applicants Only)  Copy of Service Record Book (Prior Service/Reserve Marines Only)  Copy of most recent Physical Examination  Request for Conditional Release (Other Service Reservists Only) Married Applicants  Marriage Certificate (we can true copy in the office)  Divorce Decree (we can true copy in the office)  Dependent Birth Verification (we can true copy in the office) ROUGH APPLICATION INSTRUCTIONS Read all instructions carefully. This application may be typed or legibly handwritten in black ink. All forms contain instructions at the top of the page and most of them are self-explanatory; however, some additional guidance is required to ensure they are completed correctly and completely. All non-applicable areas should be marked as such. Ensure you read the additional instructions provided below before you attempt to complete them. Contact the Officer Selection Team with any questions. STATEMENT OF UNDERSTANDING Explains the minimum requirements that must be met and maintained as an applicant. Sign and date where indicated. The OSO/OSA will sign as the witness. FAMILY ORIENTATION & PREVIOUS APPLICATION FOR MILITARY SERVICE (PAGE 3, NOT INCLUDING THIS PAGE & STATEMENT OF UNDERSTANDING) Attach additional pages if necessary. If certain information is unknown, write "Unknown" after you've made a reasonable attempt to acquire the requested information. ACADEMIC CERTIFICATION FORM (PAGE 11, NOT INCLUDING...) Sign and date the front of the document (not the back) where it says Signature of Applicant and Date. The OSO/OSA will sign as the witness. DEAN RECOMMENDATION (LAST PAGE) Fill out your Name, Social Security Number and Address in the identification block. Then, sign and date where indicated. The OSO/OSA will sign as the witness. TIME SENSITIVE MATERIAL: RETURN THIS APPLICATION BY _______________ ENCLOSUR

STATEMENT OF UNDERSTANDING I understand the Officer Selection Officer and the personnel at the Officer Selection Station screen and evaluate applicants for the U.S. Marine Corps Platoon Leaders Class (PLC) and Officer Candidates Class (OCC). Final approval of my application is not made by the Officer Selection Officer, but rather by a panel of officers at the appropriate headquarters level. The only guarantees for either Program are outlined in writing and will be contained in Annexes B and C of my PLC or OCC Contract. I understand I must have a full physical examination, have and maintain a minimum of a 2.0 GPA, remain enrolled in school as a full-time student (12 credits), score at least 1000 on the SAT, 45 on the ACT (Math and English combined), or 74 on the ASVAB (QT portion), meet minimum involvement standards with legal authorities, be within age standards for the desired program for which I am applying, pass a physical fitness test and be fully evaluated by the Officer Selection Officer before my application may be submitted. I understand there are minimum requirements and academic, mental, moral and physical disqualifications cannot be waived. I understand that for my application to be competitive, I must score a minimum of 225 points out of a possible 300 on the Physical Fitness Test, which is scored as follows: Males Pull-ups (maximum = 20, each is worth 5 pts) Crunches (maximum = 100 in 2 minutes, each is worth 1 pt) 3-mile run (max = 18 minutes, one pt deducted every 10 seconds)

100 points 100 points 100 points

Females Flexed Arm Hang (maximum = 70 seconds, see scale at OST) Crunches (maximum = 100 in 2 minutes, each is worth 1 pt) 3-mile run (max = 21 minutes, one pt deducted every 10 seconds)

100 points 100 points 100 points

I understand the completion and submission of this application does not commit me to any obligation and that this Program is competitive. This completed application provides the Officer Selection Officer the screening criteria necessary to consider my request for processing. I also understand if I am fully qualified, the Officer Selection Officer is obligated to forward my completed application to the Board for consideration, but is not obligated to include a favorable recommendation on my behalf. I further understand that since the Officer Selection Officer will most likely have limited opportunity to observe me, his recommendation to the Board will largely be based upon his interaction with me during the application process combined with observations made by the rest of the Officer Selection Team.

______________________________ (Applicant's Signature & Date)

______________________________ (Witness Signature & Date

ENCLOSUR

MARINE CORPS OFFICER PROGRAMS ROUGH APPLICATION PROGRAM (Check all that apply):

PLC GRD

PLC AIR

PLC NFO

PLC LAW

OCC GRD

OCC AIR

OCC NFO

OCC LAW

APPLICANT INFORMATION Name (Last, First, Middle):

Social Security Number:

Date of Birth:

Place of Birth (City, County, State):

CURRENT/SCHOOL CONTACT INFORMATION Address While at School (Number, Street, Apartment)

Address While at School (City, County, State, ZIP)

Current Residence Phone Number:

Cell Phone Number (if applicable):

Email Address 1: Email Address 2:

HOME OF RECORD CONTACT INFORMATION Home Address (Number, Street, Apartment): Home Address (City, County, State, ZIP)

Home Phone Number:

PERSONAL INFORMATION Height:

Weight:

Vision (if known):

Sex:

Race:

Ethnic Category:

Marital Status:

Number of Children (if applicable):

Religious Preference:

Date of Application:__________________

ENCLOSUR

CURRENT EDUCATION College Currently Attending:

Last Semester GPA:

Class Standing (Fr, So, Jr, Sr):

Degree Pursuing (BS, BA, MS, MA, MBA):

Projected Graduation Date:

Declared Major:

ACT SCORES SAT SCORES

Composite:

Math:

English:

Composite:

Math:

English:

Cumulative GPA:

OTHER COLLEGES Other College # 1:

From Date:

To Date:

Graduate (Y or N):

From Date:

To Date:

Graduate (Y or N):

From Date:

To Date:

Graduate (Y or N):

Mailing Address:

Other College # 2:

Mailing Address:

Other College # 3:

Mailing Address:

HIGH SCHOOL High School

Mailing Address:

From Date--To Date:

PRIOR MILITARY SERVICE Branch:

Grade/Rank:

Date Enlisted:

Date Discharged:

RE Code:

Last Unit Served With:

Previous Unit:

ENCLOSUR

FAMILY INFORMATION Father's Name

Address

U.S. Citizen (Y or N)

Mother's Name

Address

U.S. Citizen (Y or N)

Spouse's Name

Address

U.S. Citizen (Y or N)

Child # 1's Name (if applicable)

Address

U.S. Citizen (Y or N)

Child # 2's Name (if applicable)

Address

U.S. Citizen (Y or N)

Child # 3's Name (if applicable)

Address

U.S. Citizen (Y or N)

FAMILY MEMBERS WITH MILITARY SERVICE Name

Relationship Branch of Service

Rank

Period of Service

Name

Relationship Branch of Service

Rank

Period of Service

Name

Relationship Branch of Service

Rank

Period of Service

PLEASE ANSWER THE FOLLOWING QUESTIONS: YES

NO Have you ever been, or are you now a member of any ROTC or other officer training program? Have you ever failed any type of military flight training? Have you ever been rejected for enlistment or induction into any branch of the Armed Forces? If yes, provide the date, branch and reason for rejection.

Date

Branch

Reason

Do you now, or have you ever held a security clearance? provide the date, type and basis for why you held it. Date

Type

If so,

Basis

Have you ever claimed, or been granted a pension, disability allowance, compensation or retired pay from the U.S. Government? ENCLOSUR

PERSONAL REFERENCE PAGE.

To be eligible for this Program, you must complete the Section labeled "Required References." The additional references are afforded to allow you a better chance of selection. They are highly encouraged, but not required. Do not use relatives, girlfriends/boyfriends or roommates for your two required "Other" References. You may use them as additional ones, but realize they carry little weight in the selection board's decision.

REQUIRED REFERENCES Official Title

Last Name, First Name, MI

Complete Mailing Address

Phone Number

Official Title

Last Name, First Name, MI

Complete Mailing Address

Phone Number

Official Title

Last Name, First Name, MI

Complete Mailing Address

Phone Number

Official Title

Last Name, First Name, MI

Complete Mailing Address

Phone Number

Official Title

Last Name, First Name, MI

Complete Mailing Address

Phone Number

DEAN

PROFESSO R

EMPLOYER

OTHER

OTHER

ADDITIONAL REFERENCES Official Title

Last Name, First Name, MI

Complete Mailing Address

Phone Number

Official Title

Last Name, First Name, MI

Complete Mailing Address

Phone Number

Official Title

Last Name, First Name, MI

Complete Mailing Address

Phone Number

Official Title

Last Name, First Name, MI

Complete Mailing Address

Phone Number

Official Title

Last Name, First Name, MI

Complete Mailing Address

Phone Number

Official Title

Last Name, First Name, MI

Complete Mailing Address

Phone Number

2ND DEAN (IF APPLICABLE)

OTHER

OTHER

OTHER

OTHER

OTHER

ENCLOSUR

ACTIVITES AND ACHIEVEMENTS PAGES.

The next three pages are allotted for you to list the activities you participated in and the recognitions you received for them while in high school, college and outside of school. Please list everything you can think of. I will determine what is relevant and what is not. I use this information to build your package for the Selection Board, so try to remember everything. Examples of school activities include sports, student government and fraternities/sororities. Examples of non-school affiliated activities include Boy/Girl Scouts, 4-H, Community Service Organizations.... Recognitions would include such things as, All-Conference, State Championships, Student President, Valedictorian, Eagle Scout Honor Rolls and so forth....

HIGH SCHOOL ACTIVITIES AND RECOGNITIONS YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

ENCLOSUR

COLLEGE ACTIVITIES AND RECOGNITIONS YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

NON-SCHOOL AFFILIATED ACTIVITIES AND RECOGNITIONS YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

YEAR

ACTIVITY OR RECOGNITION

ENCLOSUR

MINOR TRAFFIC OFFENSES.

List all minor traffic violations in the format provided below. If you are unsure of any information, or if you have questions regarding this form, please contact the Officer Selection Team. Note: Alcohol-related traffic offenses are NOT considered minor infractions and should be explained in detail in the NON-TRAFFIC ARREST Section on the following page. FIRST OFFENSE

SECOND OFFENSE

Month and year of violation

Month and year of violation

City & State where violation occurred

City & State where violation occurred

Original Charge

Original Charge

Charge of which convicted or to which a guilty plea was entered

Charge of which convicted or to which a guilty plea was entered

Penalty or disposition. If fined, indicate amount.

Penalty or disposition. If fined, indicate amount.

THIRD OFFENSE

FOURTH OFFENSE

Month and year of violation

Month and year of violation

City & State where violation occurred

City & State where violation occurred

Original Charge

Original Charge

Charge of which convicted or to which a guilty plea was entered

Charge of which convicted or to which a guilty plea was entered

Penalty or disposition. If fined, indicate amount.

Penalty or disposition. If fined, indicate amount.

FIFTH OFFENSE

SIXTH OFFENSE

Month and year of violation

Month and year of violation

City & State where violation occurred

City & State where violation occurred

Original Charge

Original Charge

Charge of which convicted or to which a guilty plea was entered

Charge of which convicted or to which a guilty plea was entered

Penalty or disposition. If fined, indicate amount.

Penalty or disposition. If fined, indicate amount.

ENCLOSUR List any experimentation with illegal substances in this section. If this does not apply to you, please indicate so by writing, "N/A."

DRUG STATEMENT. Type of drug used

Approximate number of times

Amounts taken

Method(s) used

Inclusive Dates (be specific)

Were you ever convicted of or arrested for this drug use?

Circumstances under which the drug use occurred (use additional sheets if necessary)

Type of drug used

Approximate number of times

Amounts taken

Method(s) used

Inclusive Dates (be specific)

Were you ever convicted of or arrested for this drug use?

Circumstances under which the drug use occurred (use additional sheets if necessary)

ENCLOSUR NON-TRAFFIC ARREST FORM. This form is to be utilized if you have ever been charged with and/or convicted of ANY alcohol-related offense, or any other non-traffic arrest no matter how minor. Answer the following questions and write a concise, but complete statement addressing the details of the incident. Month & year of violation City and State where the violation occurred Original Charge Charge of which convicted, or to which a guilty plea was entered Penalty or disposition. If fined, indicated amount Applicant's Statement addressing the circumstances surrounding this incident (use additional sheets if necessary)

Month & year of violation City and State where the violation occurred Original Charge Charge of which convicted, or to which a guilty plea was entered Penalty or disposition. If fined, indicated amount Applicant's Statement addressing the circumstances surrounding this incident (use additional sheets if necessary)

ENCLOSUR

100 WORD STATEMENT.

Using a BLACK INK PEN, write a statement explaining why you want to become a Marine Corps Officer. PENMANSHIP MUST BE LEGIBLE! Apply correct use of sentence structure, grammar and punctuation. Make sure you check your spelling. Your statement should be between 90 to 100 words, but CAN NOT EXCEED 100 WORDS! _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ _______________________________________________________________________________________ ________________________________ Applicant's Signature

ENCLOSUR

TATTOO DIAGRAM AND STATEMENT:

Provide a detailed statement of your Tattoo. What the tattoo is, where it is, how big it is, why did you get it and explain what the tattoo means to you.

ENCLOSUR

SIGNATURE I CERTIFY THAT THE INFORMATION PROVIDED BY ME IN THIS APPLICATION IS TRUE, ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE, AND IS MADE IN GOOD FAITH. I UNDERSTAND THAT MAKING A KNOWINGLY FALSE STATEMENT MAY RESULT IN A FRAUDULENT ENLISTMENT, WHICH CAN CARRY A FINE OR PERIOD OF IMPRISONMENT, OR BOTH. (U. S. CODE, TITLE18, SECTION 1001): __________________________________ SIGNATURE ___________________ DATE

ENCLOSUR

PRIVACY ACT STATEMENT

The authority to request this information is contained in Section(s) 505, 508, and 510 under Title 10 of the United States Code; which prescribes qualifications for enlistment into the Armed Forces of the United States. The information you provide will only be released to authorized personnel involved in the selection process of your application. Any and all information acquired is FOR OFFICIAL USE ONLY and will be maintained in accordance with Federal Law. Any and all information acquired by this office whether by telephone or in writing will be used to determine your suitability as a Marine Corps Officer. 1. I authorize the Department of Defense, its persons and or agencies, full authority to release any and all personal information contained herein, to include any information that may be acquired during the application process, for the purposes of selection to the program for which I am applying. 2. I acknowledge receipt, and declare full understanding of the above statements.

(Signature of Applicant)

(Social Security Number)

(Date)

ENCLOSUR

PHYSICAL FITNESS TEST (PFT) INFORMATION Before we can submit your final application, you must pass a Marine Corps PFT. It is wise to start practicing now in order to submit the most competitive score you can. Do not be discouraged if your first few attempts aren’t very impressive. We will help you do your best. Events:

Male: Pull-ups, Crunches, and a Three Mile Run Female: Flexed arm hang, Crunches, and a Three Mile Run

Standards:

All the events, pull-ups, flexed arm hang, crunches, and the three mile run have specific requirements in order to be scored correctly.

Pull-ups: To perform a pull-up the participant may be assisted to the bar by a step up, by being lifted, or by jumping up to the bar. The force of a jump may not be used for the first pull-up. The bar is grasped with both palms facing in the same direction, either in or out. The arms are fully extended and the feet are free from the ground. One repetition consists of raising the body with the arms until the chin is above the bar then lowering until the arms are fully extended again. Repeat as many times as possible. Note: any kicking or rocking motion is not permitted. The body may be kept from swinging by an assistant holding an extended arm across the front of the knees. Hand position may be changed during the exercise providing the individual does not dismount the bar, or receive assistance from anyone else. Resting is permitted in the up or down position but resting the chin on the bar is not allowed. The score is based upon how many pull-ups were done correctly.

Male pull-up

ENCLOSUR

Flexed arm hang: The participant stands on a support or, if necessary, is assisted by others to reach the starting position. The bar may be grasped with palms facing in or out, but both palms must face in the same direction. Start with the elbows bent so the chin is above or level with the bar. Once the participant is set in their starting position the support or assistance is removed. The participant attempts to hang there for as long as possible without letting her chin rest on the bar, or letting her elbows straighten. The score is the length of time in seconds that both elbows are maintained in a bent position. The chin may not rest on the bar during the exercise.

Female flexed arm hang . Crunches: The starting possition: participants lie on their backs (supine position) with legs bent at the knees and both feet flat on the ground. Arms are crossed over the lower rib. Arms must not separate from the chest during the exercise. One repetition consists of raising the upper body from the supine position until the forearms touch both legs then returning to the supine position. Repeat as many times possible within two minutes. It is necessary for the the feet and buttocks to remain in constant contact with the ground. Upon return to the supine position the shoulder blades must touch the ground to complete the repetition. The head does not need to touch the ground. An assistant may grasp the participant’s feet or legs below the knees -whichever manner is more comfortable for the participant. Kneeling or sitting on the feet is permitted. Participants may rest in either the up or down position.

Crunches 3 mile run: Males and females both run three miles. The objective of this event is to complete the measured distance as quickly as possible. ENCLOSUR

POINT SYTEM AND SCORING A PFT score is the combination of all events. The maximum score for a PFT is 300 points. There are 100 points possible for each event. Pull-ups:

Pull-up’s are worth 5 points each. You are limited to 20 pull-ups for the maximum score of 100.

Flexed arm hang:

Every second is worth 1 point until 40 seconds, thereafter every second is worth 2 points. The maximum value is 70 seconds for 100 points.

Crunches:

Crunches are worth 1 point each. The time limit is 2 minutes. Your are limited to 100 crunches for a maximum score of 100 points.

3 mile run:

Males must finish in 18 minutes or less in order to achieve the maximum score. Females in 21 minutes or less. For every 10 seconds thereafter subtract 1 point from the maximum of 100 points. For example: A male finishes his run at 18:04, his score is 99. One point was deducted for the 1st 10 second increment after his 18 allotted minutes.

HELPFUL HINTS

In order to obtain the best possible score, you must practice for the PFT. This does not mean running on a treadmill, doing cardio workouts at the gym, or doing any other sort of fancy conditioning routine. In order to increase pull-ups & hang time, you must find a bar and practice. In order to increase the number of crunches, you must do 100 crunches every night – crunches are gained quickly, but lost just as quickly if you don’t do them. In order to lower your run time, you must get out there and run.

ENCLOSUR

This is important:

Carefully detach and KEEP the following pages in a safe, protected place!! Retain these forms for future use. They must be well kept, neat and on hand ready to use.

ENCLOSURE ENCLOSURE

LEVEL OF ACTIVITY STATEMENT

A Level of Activity (LOA) Statement is an essential part of your Physical Examination. The information you provide must be accurate and true to the best of your knowledge. Print all information requested. Sign in the space provided. 1. What physical activities are you currently involved in? Include individual and team sports as well as anything physically demanding at your job.

2. How many times per week and for how long do you participate in each activity?

3. Do you have any physical limitations that would interfere or restrict you in any way form performing strenuous physical activity? If “YES”, list the condition(s).

4. Have you ever had any sports or physical activities injuries? If “YES”, explain in detail.

5. List all surgical, chiropractic and/or other medical treatment for which you required care, other than minor conditions (e.g.. the flu), within the last two years.

6. Is there any reason that you could not fully participate at OCS or be commissioned as a United States Marine Corps Officer as scheduled? If “YES”, explain.

Printed name of applicant___________________________________________________ Signature of applicant _________________________________________ Date _________

ENCLOSURE

MPPM OFF PROC STATEMENT OF UNDERSTANDING REGARDING DENTAL REQUIREMENTS PRIOR TO ATTENDING OFFICER CANDIDATE SCHOOL I have been advised by my OSO that it is my personal responsibility to ensure that all dental defects are corrected and orthodontic appliances are removed prior to reporting to training. Failure to obtain dental examination from a qualified dentist and correction of any deficiencies to include cavities, partial plates, caps, root canals, and extractions my be grounds for my disenrollment prior to the commencement of training at Officer Candidate School, Quantico, Virginia.

____________________________________________ Applicant Signature:

____________________________________________ Date:

Witnessed by :__________________________________________ OSO/MOI

Note: The cursory dental check received at a Military Entrance and Processing Station (MEPS) does no constitute a proper dental examination per the medical provisions of an Officer Candidate Program.

ENCLOSURE UNITED STATES MARINE CORPS OFFICER SELECTION OFFICE 2025 Guadalupe St Suite 136 Austin TX 78705 IN REPLY REFER TO

952/1 AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION I am seeking a Commission with the United States Marine Corps, which requires information regarding my fitness for active duty. I hereby authorize a representative of the United States Marine Corps, conducting and investigation of my medical qualifications, to obtain the requested information relating to my medical history and treatment. Detailed information from doctor and or hospital should include: 1. Diagnoses 2. Results of any and all test performed to include: X-rays, blood work, pathology reports, etc. 3. Treatment prescribed to include: medication, therapy, etc. 4. Final prognosis to include any and all limitations or restrictions. The requested information should be forwarded to: United States Marine Corps Officer Selection Office 2025 Guadalupe St. STE#136 Austin, TX 78705

phone: (512) 477-5706

fax: (512) 477-0958

Questions regarding this request should be directed to Mr Mike DeFee at (512) 477-5706 or toll free (800) 858-8762 ext. 907. This is an extremely time sensitive issue and your prompt attention will be greatly appreciated. ________________________________________ Signature ________________________________________________ Other Names Used

_______________________________________ Typed or Printed Full Legal Name _______________________________________________ Social Security Number

__________________________________________________________________________________________________ Current Address City State Zip ________________________________________________ Home Telephone Number

_______________________________________________ Date

ENCLOSURE

ACADEMIC CERTIFICATION FORM UNITED STATES MARINE CORPS OFFICER SELECTION OFFICE 2025 Guadalupe St., Suite 136 Austin, TX 78705 (512) 477-5706

Dear Registrar, The student whose name appears on the reverse side has applied for enrollment in a Marine Corps officer program, or is already a member of such a program. A minimum grade point average is required for admission to, or retention in all of our programs. Accordingly, I am requesting your cooperation in furnishing essential information regarding this individual's academic status so that a fair determination can be made in his or her case. I realize a great many demands are placed upon your time and this request may cause some inconvenience. Please be assured of the importance of this data and the weight given to it by the Marine Corps. Please call my office with any questions at (512) 477-5706. Thank for your assistance.

J. M. Tew Captain, U.S. Marine Corps Officer Selection Officer Please forward the completed Academic Certification found on the reverse side of this letter along with official transcripts to: Marine Corps Officer Selection Station 2025 Guadalupe St., Ste. 136 Austin, TX 78705 _________________________________________________________________________ I am aware of the provisions of the Family Education Rights Act. I hereby authorize release of the requested information and an official transcript directly to the Marine Corps agency indicated on this form.

______________________ (Signature of Witness)

______________________

____________

(Signature of Applicant)

(Date)

ENCLOSURE (7)

ACADEMIC CERTIFICATION FOR MARINE CORPS OFFICER CANDIDATE PROGRAMS (1530) NAVMC 10469 (REV. 6-91) SN: 0000-00-005-1108 U/l: PADS OF 100 (Previous edition will not be used)

FORM APPROVED OMB NO. 0703-0011

S

Public reporting burden for this collection is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of the collection of information, including suggestions for reducing the this burden, to Washington Headquarters Services, Directorate for Information Operations and reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302; and to the Office of Management and Budget, PAPERWORK REDUCTION PROJECT (0703-0011), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send your completed form to: COMMANDANT OF THE MARINE CORPS (MROR), Washington, DC 20380-0001.

NAME OF STUDENT

SOCIAL SECURITY NUMBER

COLLEGE OR UNIVERSITY This is to certify that the above named student:

IS

IS NOT

a regularly enrolled full-time student at this institution.

IS

IS NOT

carrying an academic course load of 12 hours per semester of equivalent load on the quarter system.

Provided progress is normal, and contingent upon satisfactory completion of work, it is expected that the above names student will complete requirements for the following degree:  Associate in Arts/Science (Junior College only) Baccalaureate 

Bachelor of Laws/Jurist Doctor Expected date of completion of degree requirements: _____________________________

The below information is required to determine this student’s eligibility for admission to, or retention in, one of the U. S Marine Corps Officer Candidate Programs: Major Subject

_____________________________

Total number of hours/units attempted

_________________

Total number of hours/united completed _________________ Total number of grade point average

_________________

Cumulative grade point average

__________________

At this institution a grade point average of ________________ Is equivalent to a “C”. SAT Score

Math __________

Verbal __________

ACT Score

Math __________

Verbal __________

It is requested that a certified copy of the student’s transcript be returned with this form. REMARKS: SIGNATURE _________________________________________________________

PLEASE AFFIX SEAL

TITLE

_____________________________________________________________

ENCLOSURE DATE _____________________________________________________________ (7)

DEAN REFERENCE QUESTIONNAIRE- PIQ

UNITED STATES MARINE CORPS OFFICER SELECTION OFFICE 2025 Guadalupe St., Suite 136 Austin, TX 78705 (512) 477-5706

To Whom It May Concern: The person named below has applied for an officer training program in the United States Marine Corps. As part of this process he/she is required to provide a minimum of five references, to include one from the Dean of his/her respective university. We understand you may not personally know or have observed this individual. Our main purpose in requiring a reference from the Dean is to determine whether the student is or ever was the subject of any type of academic probation or disciplinary action while at your University. Accordingly, we ask that you check the appropriate block on the reverse side of this form and if applicable, to please elaborate. If you do know the student personally, or if you observed any of the traits listed on the form, please mark them appropriately. This Program may lead to an appointment as a commissioned officer in the United States Marine Corps. When selecting candidates for appointment as officers, decisions are made on the basis of all available, relevant information regarding the applicant's background in terms of education, intelligence, experience and personal characteristics. This information is extremely important as it will assist a panel of officers at Headquarters, Marine Corps in determining the officer potential of this Candidate. The information you furnish will be treated confidentially. However, under the Freedom of Information Act and the Privacy Act of 1974, a copy of this completed form may be released if requested by the applicant. This form is authorized by Marine Corps Order P1100.73. Although you are not required to respond, your cooperation in this matter is greatly appreciated. A return addressed, postage free envelope has been provided for your convenience in returning this rating schedule. Sincerely,

J.M. Tew Captain, U.S. Marine Corps Applicant Release Statement I am aware of the provisions of the Family Education and Privacy Right Act. I hereby authorize the release of the requested information directly to the Marine Corps agency indicated on this form. I desire that an objective evaluation be rendered.

__________________________ (Signature of Witness) NAME OF APPLICANT SOCIAL SECURITY NUMBER ADDRESS

____________________________ (Signature of Applicant) __________________ (Date) Due by: TIME SENSITIVE MATERIAL

ENCLOSURE (8) DEAN REFERENCE QUESTIONNAIRE- PIQ

Public reporting burden for this collection is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any aspect of this collection of information, including suggestions for reducing this burden to, Department of Defense, Washington Headquarters Services, Directorate for Information and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302; and to the Office of Management and Budget, Paperwork Reduction Project (0703-0012), Washington, DC 20503

REFERENCE QUESTIONNAIRE INSTRUCTIONS Evaluate the candidate on all sixteen of the factors listed below. Mark only one choice that best describes the qualities of the applicant in relation to those of his/her peers. GENERAL COMMENTS – IN YOUR OWN WORDS, PLEASE GIVE A SUMMARY EVALUATION OF THE APPLICANT

PLEASE CIRCLE EITHER HAS OR HAS NOT THIS STUDENT HAS / HAS NOT BEEN ON DISCIPLINARY PROBATION WHILE ATTENDING THIS INSTITUTION

PERSONAL REFERENCE QUESTIONNAIRE-

UNITED STATES MARINE CORPS OFFICER SELECTION OFFICE 2025 Guadalupe St., Suite 136 Austin, TX 78705 (512) 477-5706

To Whom It May Concern: The person named below has applied for an officer training program in the United States Marine Corps. As part of this process he/she is required to provide a minimum of five references, to include one from the Dean of his/her respective university. We understand you may not personally know or have observed this individual. Our main purpose in requiring a reference from the Dean is to determine whether the student is or ever was the subject of any type of academic probation or disciplinary action while at your University. Accordingly, we ask that you check the appropriate block on the reverse side of this form and if applicable, to please elaborate. If you do know the student personally, or if you observed any of the traits listed on the form, please mark them appropriately. This Program may lead to an appointment as a commissioned officer in the United States Marine Corps. When selecting candidates for appointment as officers, decisions are made on the basis of all available, relevant information regarding the applicant's background in terms of education, intelligence, experience and personal characteristics. This information is extremely important as it will assist a panel of officers at Headquarters, Marine Corps in determining the officer potential of this Candidate. The information you furnish will be treated confidentially. However, under the Freedom of Information Act and the Privacy Act of 1974, a copy of this completed form may be released if requested by the applicant. This form is authorized by Marine Corps Order P1100.73. Although you are not required to respond, your cooperation in this matter is greatly appreciated. A return addressed, postage free envelope has been provided for your convenience in returning this rating schedule. Sincerely,

J.M. Tew Captain, U.S. Marine Corps HOW LONG HAVE YOU KNOWN THE APPLICANT SIGNATURE

RELATION TO THE APPLICANT (Professor, Employer, etc.)

PROFESSION Applicant Release Statement

NAME OF FIRM OR INSTITUTION

ENCLOSURE (8)

I am aware of the provisions of the Family Education and Privacy Right Act. I hereby authorize the release of the requested information directly to the Marine Corps agency indicated on this form. I desire that an objective evaluation be rendered.

__________________________ (Signature of Witness)

____________________________ (Signature of Applicant) __________________ (Date)

NAME OF APPLICANT SOCIAL SECURITY NUMBER

Due by: TIME SENSITIVE MATERIAL

ADDRESS

ENCLOSURE (9)

PERSONAL REFERENCE QUESTIONNAIRE Public reporting burden for this collection is estimated to average 30 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any aspect of this collection of information, including suggestions for reducing this burden to, Department of Defense, Washington Headquarters Services, Directorate for Information and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302; and to the Office of Management and Budget, Paperwork Reduction Project (0703-0012), Washington, DC 20503

REFERENCE QUESTIONNAIRE INSTRUCTIONS Evaluate the candidate on all sixteen of the factors listed below. Mark only one choice that best describes the qualities of the applicant in relation to those of his/her peers.

Please write comments in this space or print “see attached letter” if including a reference letter.

Instructions: 1. Check YES or NO to all of the below 75 questions. 2. Anything you answer YES to EXPLAIN in detail who/what/when/where/and current status of the issue in section “1b.” 3. Most importantly, if you answer YES to any question (except 34, 73) you MUST bring in any & all-medical documents pertaining to this issue. If you cannot locate medical documents then you must write a standard letter to “To whom it may concern” explaining in detail the nature of the issue, dates, how it occurred, the current status if any and why you cannot collect medical documents (i.e. medical documents lost and cannot locate doctor, etc.) 1. Mark each item “YES” or “NO”. Every item marked “YES” must be fully explained in item 1b. a. HAVE YOU EVER HAD OR DO YOU HAVE: YES NO

HOW LONG HAVE YOU KNOWN THE APPLICANT SIGNATURE

YES

RELATION TO THE APPLICANT (Professor, Employer, etc.)

PROFESSION

NAME OF FIRM OR INSTITUTION

ENCLOSURE (9)

NO

) Asthma, wheezing, or inhaler use (24) Any other heart problems b. EXPLAIN ALL “YES” ANSWERS TO QUESTIONS (1)-(75) ABOVE. ( Describe answer(s), give date(s) of problems, name doctors(s), clinic(s), hospital(s), treatment given and current (2) Dislocated joint, including knee, hip, shoulder, elbow, ankle (25) High blood pressure medical status. Use the back or attach additional sheet(s) if necessary.) (3) Recurrent neck or back pain (26) Discharged from military service for medical reasons (4) Sleepwalking (27) Ulcer (stomach, duodenum or other part of intestine) (5) Recurrent neck or back pain (28) Received disability compensation for an injury or other medical condition (6) Rheumatic fever (29) Hepatitis (liver infection or inflammation) (7) Foot pain (30) Intestinal obstruction (locked bowels), or any other chronic or recurrent (8) A swollen, painful, or dislocated joint or fluid in a joint (knee, intestinal problem, including small intestine or colon problems, such as shoulder, wrist, elbow, etc.) Crohn’s disease or colitis (9) Double vision (10) Periods of unconsciousness (31) Detached retina or surgery for a detached retina (11) Frequent or severe headaches causing loss of time from work or (32) Surgery to remove a portion of the intestine (other than the appendix) school or taking medication to prevent frequent or severe (33) Any other eye condition, injury or surgery headaches (34) Are you over 40? (If so, call the MEPS for information on special (12) Wear contact lenses (If so, bring your contact lens kit and requirements for over-40 physicals) solution so you can remove your contact when we test your vision (35) Gall bladder trouble or gall stones at the MEPS; also, if you have a pair of eyeglasses, bring them with you no matter how old they are.) (36) Jaundice (37) Missing a kidney (13) Fainting spells or passing out (14) Head injury, including skull fracture, resulting in concussion, loss of consciousness, headaches, etc. (15) Back surgery (16) Seen a psychiatrist, psychologist, counselor or other professional for any reason (inpatient or outpatient) including counseling or treatment for school, adjustment, family, marrieage or any other problem, to include depression, or treatment for alcohol, drug or substance abuse (17) Any of the following skin diseases: ( a) Eczema ( b) Psoriasis ( c) Atopic dermatitis (18) Irregular heartbeat, including abnormally rapid or slow heart rates (19) Allergic to bee, wasp, or other insect stings (itching/swelling all over and/or get short of breath) (20) Heart murmur, valve problem or mitral valve prolapse (21) Allergic to wool (22) Heart surgery (23) Been rejected for military service (temporary or permanent) for medical or other reasons (50) Pain or swelling at the site of an old fracture (51) Perforated ear drum or tubes in ear drum(s) (52) Anemia (4) (53) Ear surgery, to include mastoidectomy or repair of perforated ear drum (54) Night blindness (55) Arthritis (56) Absence or disturbance of the sense of smell (57) Absence or removal of the spleen, or rupture or tear of the spleen without removal (58) Anorexia or other eating disorder (59) Cracked bone or fracture(s) (60) Bursitis (61) Braces (If you wear or are planning on obtaining braces for your teeth, have the orthodontist submit a letter stating that braces will be removed before active duty date; release form and sample format can be found in the Recruiter’s Medical Guide.) (62) Loss of finger, toe or part thereof (63) Loss of the ability to fully flex (bend) or fully extend a finger, toe or other joint

(38) Allergy to common food (milk, bread, eggs, meat, fish or other common food) (39) (Females only) Abnormal PAP smear or gynecological problem (40) (Males only) Missing a testicle, testicular implant, or undescended testicle (41) Broken bone requiring surgery to repair (with or without pins, plates, screws or other metal fixation devices used in repair) (42) Ruptured or bulging disk in your back or surgery for a ruptured or bulging disk (43) Thyroid condition or take medication for your thyroid (44) Limitation of motion of any joint, including knee, shoulder, wrist, elbow, hip or other joint (45) Drug or alcohol rehab (46) Kidney, urinary tract or bladder problems, surgery, stones or other urinary tract problems (47) Sugar, protein or blood in urine (48) Surgery on a bone or joint (knee, shoulder, elbow, wrist, etc.) including arthroscopy with normal findings (49) Taking any medications (If so, list reason in item 1b.) (64) Shoulder, knee, or elbow problem (out of place) (65) Locking of the knee or other joint (66) Giving way of knee or other joint (67) Cataracts or surgery for cataracts (68) Eye surgery, including radial keratotomy, lens implant or other eye surgery to improve your vision (69) Collapsed lung or other lung condition (70) Bed wetting since age 12 (71) Evaluation, treatment, or hospitalization for alcohol abuse, dependence, or addiction (72) Taken medication, drugs, or any substance to improve attention, behavior, or physical performance (73) Do you smoke? (If yes:) (a) Type Cigarettes (b) How many per day?

Cigars

Smokeless tobacco ( c) Date last used

(74) Evaluation, treatment, or hospitalization for substance use, abuse, addiction or dependence (including illegal drugs, prescription medications, or other substances) (75) Any illnesses, surgery, or hospitalization not listed above

EMPLOYMENT DATA LIST ALL PERIODS OF EMPLOYMENT THAT YOU HAVE HAD: FROM (Month

TO & Year)

NAME OF BUSINESS City & State

IMMEDIATE SUPERVISOR

REASON FOR LEAVING

POSITION HELD

DESCRIBE ANY JOB POSITION WHERE YOU WERE GIVEN SPECIAL TRUST AND CONFIDENCE, OR ANY MANAGEMENT EXPERIENCES YOU HAVE HAD: