Cc Form 167 R PDF Details

The CC 167 R form serves as the official document for individuals awarded an Army ROTC Scholarship to either accept or decline their scholarship offer. This vital step in the ROTC scholarship process is guided by clear regulations outlined in CC Reg 145-1, ensuring that the ROTC Cadet Command is promptly informed of the decision. It captures crucial information including the type of scholarship, personal data of the recipient, and the chosen institution of higher learning. Moreover, this form addresses the necessity of maintaining accurate counts of acceptances and declinations, facilitating the allocation of awards to alternates efficiently. It requests detailed reasons for any declinations, thereby aiding in statistical analyses of enrollment trends and assisting in better future planning for the ROTC. The form also plays a crucial role in the administrative process, including the allocation of funds for covering costs and mailing medical forms requisite for cadet personnel files. Disclosure of information on the CC 167 R form is mandatory, underpinning the importance of timely communication with the ROTC Cadet Command to avoid forfeiture of the scholarship. This document is not just a formality but a critical link between scholarship recipients, their future military education, and their commitment to service.

QuestionAnswer
Form NameCc Form 167 R
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namescc 167, PMS, 3-Year, grfd

Form Preview Example

U. S. ARMY ROTC SCHOLARSHIP ACCEPTANCE/DECLINATION STATEMENT AND PMS VALIDATION

 

For use of this form, see CC Reg 145-1, the proponent agency is ATCC-OP-I-S

 

 

 

DATA REQUIRED BY THE PRIVACY ACT OF 1974

 

 

Authority

10 USC 2101 and 2107.

Principal Purpose(s)

To notify ROTC Cadet Command that winner accepts or declines a scholarship offer. Notifies which institution winner

 

will attend and reason if scholarship offer is declined.

Routine Uses

To maintain count of acceptances/declinations to enable ROTC Cadet Command to make awards to alternates. Information on

 

the institution is obtained to identify enrollment and allocation of funds to pay costs. Information is also used to mail medical

 

forms to be included in the cadet personnel file. Information on why recipient declines is maintained for statistical studies of

 

enrollment trends. Information is used by ROTC Cadet Command and to provide specific data to ROTC Regions and PMS.

Disclosure

Mandatory or voluntary disclosure and effect on individual not providing information - all data is mandatory. Individuals

 

who do not notify ROTC Cadet Command of acceptance will lose their scholarship.

1. NAME OF INSTITUTION

2. SCHOOL CODE (FICE CODE)

3.NAME OF WINNER (Last Name, First Name, MI)

4. SOCIAL SECURITY NUMBER (no dashes)

5. SCHOLARSHIP TYPE (CHECK ONE)

2-Year Campus Based

2-Year Graduate Program

2-Year GRFD-ARNG

2-Year Dedicated ARNG

2-Year GRFD-USAR

2-Year Leader's Training Course (LTC)

2-Year Military Junior College (MJC)

2-Year Green to Gold

2-Year Graduate Green to Gold

2-1/2 - Year GRFD-ARNG

3-Year (or 2-1/2-Year) Campus Based 3-Year GRFD-ARNG

3-Year Green to Gold

3-Year Advance Designee (AD)

4-Year (or 3-1/2-Year) Campus Based

4-Year Green to Gold

4-Year High School

6. DECISION:

 

ACCEPT

 

DECLINE

7. REASON FOR DECLINATION:

1 - Commitment

2 - Academic Major Restriction

3 - Non-Military Scholarship

4 - Other Military Scholarship

5 - ROTC Too Time Consuming

6 - No Longer Interested

7 - Other (Please explain)

PMS VALIDATION OF 3- AND 2-YEAR ADVANCE DESIGNEES

(TRANSCRIPT MUST BE INCLUDED FOR VALIDATION)

1. GPA, Academic

 

2. GPA, ROTC

Cumulative

 

Cumulative

No more than 4.0 will be entered. If other than a 4-point scale, convert using the table in CC Reg 145-1.

3. MAJOR SUBJECT:

ACADEMIC MAJOR CODE :

4. STATUS OF MEDICAL QUALIFICATION:

Qualified

Has Changed (Physical submitted to DoDMERB)

5. PMS RECOMMENDATION:

Recommended

Not Recommended

6.PROJECTED GRADUATION DATE (YYYYMM):

7.SCHOLARSHIP AWARD DATE(YYYYMMDD):

8.PMS REMARKS:

SIGNATURE OF PMS

 

DATE (YYMMDD)

I, the undersigned, hereby acknowledge receipt of notification of my selection for the award of an Army ROTC Scholarship. In accepting this scholarship I understand that I will obtain a degree in the academic major indicated on my application/contract or I may lose my scholarship if I change to another academic discipline without prior written consent of the Professor of Military Science.

8. SIGNATURE

9. DATE

CC FORM 167-R, OCT 2005

PREVIOUS EDITIONS ARE OBSOLETE

How to Edit Cc Form 167 R Online for Free

By using the online PDF tool by FormsPal, you're able to fill in or alter 2-YEAR right here and now. Our tool is continually evolving to provide the very best user experience attainable, and that is thanks to our dedication to continual enhancement and listening closely to user comments. Here is what you'll need to do to begin:

Step 1: Simply press the "Get Form Button" at the top of this site to launch our pdf editing tool. This way, you'll find everything that is needed to work with your file.

Step 2: The tool grants the ability to change PDF files in a range of ways. Modify it by writing any text, correct original content, and put in a signature - all readily available!

For you to fill out this document, ensure that you type in the necessary details in each area:

1. To get started, while filling in the 2-YEAR, start in the part that contains the subsequent blank fields:

Writing part 1 of PMS

2. Soon after finishing the previous section, go on to the subsequent step and enter the necessary details in these blank fields - Year or Year Campus Based, PMS RECOMMENDATION, Year GRFDARNG, Year Green to Gold, Recommended, Not Recommended, Year Advance Designee AD, PROJECTED GRADUATION DATE YYYYMM, Year or Year Campus Based, Year Green to Gold, Year High School, SCHOLARSHIP AWARD DATEYYYYMMDD, DECISION, ACCEPT, and DECLINE.

Writing segment 2 in PMS

Always be extremely mindful while filling in ACCEPT and Year Green to Gold, as this is the section where a lot of people make mistakes.

Step 3: Ensure that your details are right and then press "Done" to progress further. Get your 2-YEAR once you register at FormsPal for a free trial. Readily access the pdf file in your FormsPal cabinet, along with any edits and changes being conveniently synced! We don't sell or share any details that you provide whenever working with documents at FormsPal.

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