Afrotc Form 35 – Fill Out and Use This PDF

FOR OFFICIAL USE ONLY (When filled in)

CERTIFICATION OF INVOLVEMENTS WITH CIVIL, MILITARY OR SCHOOL

AUTHORITIES/LAW ENFORCEMENT OFFICIALS

I.	STATEMENT TO THE APPLICANT/CADET

A.The Detachment Commander must know if you have ever been arrested, convicted, involved with law enforcement officials or authorities for him/her to determine if you meet the character requirements for membership in Air Force ROTC. It is necessary for you to report any involvement with civil, military, or school authorities/law enforcement officials regardless of its insignificance, disposition, or finding on the certification provided below. Include traffic violations and any incidents which resulted in your being judged a juvenile offender. A finding of not guilty or advice by an attorney, court official, or anyone else to consider your record as clear does not constitute authority to leave the involvement off of the certification.

B. In the future, you must report any civil involvements to the Detachment Commander or his/her designated representatives within 72 hours following its occurrence. If such incidents occur during a period of leave from the institution (e.g., student teaching or foreign study), attendance at Field Training, or during normal vacation periods, the 72-hour time limit will apply effective with the official date of your return to the institution.

C.Concealing or failing to report an involvement with civil, military, or school authorities/law enforcement officials, giving false information or claiming subsequent to initial certification that you were unaware of the contents of this document may result in elimination from consideration for membership in the Air Force ROTC program; or, if already a member, may result in your discontinuance from the Air Force ROTC program. The information reported on this certification form will be treated as confidential matter, subject to the provisions of the Privacy Act of 1974 and the Freedom of Information Act.

				CERTIFICATE
I,				CERTIFY THAT THE INFORMATION CONTAINED IN THE FOLLOWING CERTI-
FICATIONS INCLUDES ALL ARRESTS, DETENTIONS, CONVICTIONS, INVOLVEMENTS, ETC., THAT I HAVE HAD WITH CIVIL, MILITARY (INCLUDING
ART. 15S), OR SCHOOL AUTHORITIES/LAW ENFORCEMENT OFFICIALS REGARDLESS OF DISPOSITION OR SEEMING INSIGNIFICANCE. THE LISTS
ARE COMPLETE AND ACCURATE TO THE BEST OF MY KNOWLEDGE AND BELIEF.
II.				CERTIFICATION I
TYPE OF INVOLVEMENT / ORIGINAL		DATE OF		NAME AND ADDRESS OF ARRESTING	DISPOSITION/FINDING
	CITATION	INVOLVEMENT		AUTHORITY/COURT	AND SENTENCE

WERE YOU DETAINED, CONFINED,

WAS THE USE OF DRUGS OR

ACTION

OR PLACED ON PROBATION FOR

ALCOHOL CITED?

NO ACTION REQUIRED

CORROBORATION REQUESTED

ANY OF THE ABOVE?

WAIVER GRANTED

CORROBORATION RECEIVED

YES

NO

YES

NO

WAIVER DENIED

SIGNATURE OF CADET

DATE

REQUEST FOR WAIVER FORWARDED

TO AFROTC/RRFP

APPROVED

DISAPPROVED

REMARKS/COUNSELING

Cadet has been counseled that his/her conduct will be closely monitored and any future involvements with authorities may result in disenrollment investigation/dismissal. Cadet's initials of acknowledgement: ________

SIGNATURE OF AUTHORIZED REPRESENTATIVE	GRADE	DATE

AFROTC FORM 35, 20100719

PREVIOUS EDITIONS ARE OBSOLETE.

FOR OFFICIAL USE (When filled in)

III.

CERTIFICATION II

TYPE OF INVOLVEMENT / ORIGINAL

DATE OF

NAME AND ADDRESS OF ARRESTING

DISPOSITION/FINDING

CITATION

INVOLVEMENT

AUTHORITY/COURT

AND SENTENCE

WERE YOU DETAINED, CONFINED,

WAS THE USE OF DRUGS OR

ACTION

OR PLACED ON PROBATION FOR

ALCOHOL CITED?

NO ACTION REQUIRED

CORROBORATION REQUESTED

ANY OF THE ABOVE?

WAIVER GRANTED

CORROBORATION RECEIVED

YES

NO

YES

NO

WAIVER DENIED

SIGNATURE OF CADET

DATE

REQUEST FOR WAIVER FORWARDED

TO AFROTC/RRFP

APPROVED

DISAPPROVED

REMARKS/COUNSELING

Cadet has been counseled that his/her conduct will be closely monitored and any future involvements with authorities may result in disenrollment investigation/dismissal. Cadet's initials of acknowledgement: ________

SIGNATURE OF AUTHORIZED REPRESENTATIVE

GRADE

DATE

IV.

CERTIFICATION III

TYPE OF INVOLVEMENT / ORIGINAL

DATE OF

NAME AND ADDRESS OF ARRESTING

DISPOSITION/FINDING

CITATION

INVOLVEMENT

AUTHORITY/COURT

AND SENTENCE

WERE YOU DETAINED, CONFINED,

WAS THE USE OF DRUGS OR

ACTION

OR PLACED ON PROBATION FOR

ALCOHOL CITED?

NO ACTION REQUIRED

CORROBORATION REQUESTED

ANY OF THE ABOVE?

WAIVER GRANTED

CORROBORATION RECEIVED

YES

NO

YES

NO

WAIVER DENIED

REQUEST FOR WAIVER FORWARDED

SIGNATURE OF CADET

DATE

TO AFROTC/RRFP

APPROVED

DISAPPROVED

REMARKS/COUNSELING

Cadet has been counseled that his/her conduct will be closely monitored and any future involvements with authorities may result in disenrollment investigation/dismissal. Cadet's initials of acknowledgement: ________

SIGNATURE OF AUTHORIZED REPRESENTATIVE	GRADE	DATE

AFROTC FORM 35, 20100719 REVERSE