Referral Request for Information

All fields are required.

MAC:

Activity Title:

GoArmy Title:

MAC Please enter a MAC

First Name Please enter a First Name Last Name Please enter a Last Name Birth Date Please enter a Birth Date Email Address Please enter an Email Address Phone Number Please enter a Phone Number ZIP Code Please enter a ZIP Code

Now, who referred you?

Fill in the first and last names of the person who referred you, along with their Department of Defense identification number (DoD ID #) for proof of service and phone number if they want to receive status updates. Their information is protected and maintained by the Privacy & Security Notice

First Name Please enter DoD agent's First Name Last Name Please enter DoD agent's Last Name DoD ID # Please enter DoD agent's ID Phone Number (Optional) Please enter DoD agent's Phone Number

Answer True or False to the following statements based on your current situation (optional).

I’m a U.S. citizen or permanent and legal resident (I-551 card).

True

False

I am in high school, have a high school diploma, or am enrolled in college.

True

False

I don’t have any tattoos.

True

False

I don’t have any medical concerns.

True

False

I don’t have any law violations.

True

False

I’m ready to talk to a recruiter to learn more.

True

False

Find ROTC programs at schools you’re most interested in.

This helps us connect you to the right person. If you’re not sure yet, just select undecided.

School selection is required.

I consent to receiving up to two automated marketing texts per week from the U.S. Army. Message and data rates may apply. Text HELP for support, STOP to opt out. See the Privacy Policy. (Optional)

Privacy Act Notice: The above disclosure is voluntary. All information will be used strictly for recruiting purposes. The authority for the collection of this information is Title 10, United States Code, Sections 503, 505, 508, and 12102, and EO 9397. For more information, please review our Privacy & Security Notice.

Referral

Tell us who referred you.

Tell us about yourself.

Now, who referred you?

Answer True or False to the following statements based on your current situation (optional).

Find ROTC programs at schools you’re most interested in.

My Jobs

Tell us about yourself.

Now, who referred you?

Answer True or False to the following statements based on your current situation (optional).

Find ROTC programs at schools you’re most interested in.

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