Cc Form 173 R PDF Details

Embarking on a journey from serving in the military to pursuing higher education and leadership roles, the Green to Gold Scholarship Program stands as a beacon of opportunity for active duty soldiers. With the Cc 173 R form at the heart of this transition, it embodies more than just a document; it is the gateway to a transformative chapter in the lives of countless service members. This form, requisite for the U.S. Army ROTC Green to Gold 4-, 3-, and 2-year scholarship applications, is governed by the dictates of CC Reg 145-1, under the stewardship of the proponent agency ATCC-OP-I-S. Mandated by the Privacy Act of 1974, it collects essential data ranging from personal identification to military service records, academic aspirations, and more, all pivotal for evaluating eligibility and selection for these coveted scholarships. Beyond mere procedural necessity, the disclosure of these details facilitates a thorough and fair assessment process, ensuring that the opportunity to lead as an officer through academic achievement is accorded to those most deserving. Through this form, the aspirations of many to transition from military ranks to collegiate realms and ultimately, to leadership roles within the Army, begin to take shape, furnished by the promise of support, education, and future success.

QuestionAnswer
Form NameCc Form 173 R
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other names173-R, 2-Yr2, USC, A-1

Form Preview Example

A-1

U.S. ARMY ROTC GREEN TO GOLD 4-, 3-, AND 2-YEAR SCHOLARSHIP APPLICATION

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

DATA REQUIRED BY THE PRIVACTY ACT OF 1974

Authority

10 USC 2102 and 2107.

Principal Purpose

Form is used to make application for a Green to Gold 4-, 3-, or 2-year scholarship.

Routine Uses

Form is used to obtain selection and eligibility information on applicants for 4-, 3-, or 2-year scholarships.

Disclosure

Information provided on this form is mandatory, without the data provided on this form, the application cannot be considered for a scholarship.

1.

SSN

2a. LAST NAME

 

 

 

 

 

 

 

2b. FIRST NAME

 

 

 

2c. MI

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3.

DATE OF BIRTH (Enter as YYMMDD)

4.

SEX (M-Male, F-Female)

 

 

 

 

5. RACE/ETHNIC CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

6a.

HOME ADDRESS: STREET

 

 

 

 

 

6b.

CITY

 

 

 

 

 

 

6c. STATE

6d. ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7a.

WORK ADDRESS: STREET (Unit of Assignment)

 

7b.

CITY

 

 

 

 

 

 

7c. STATE

7d. ZIP CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8a.

TELEPHONE NUMBER: HOME

 

 

 

 

9.

MARITAL

11. SPOUSE MILITARY

12a. SOURCE OF

 

 

13. RANK

 

 

 

(Include Area Code/Include Country Code for overseas)

 

STATUS

 

(Y-Yes, N-No)

 

CITIZENSHIP

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8b.

TELEPHONE NUMBER: WORK

 

 

 

 

10.

NUMBER OF DEPENDENTS

 

 

12b. NATURALIZATION NUMBER

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14a.

DATE OF ENLISTMENT

14b. ENLISTED EXPIRATION

 

15.

MOS

16. GENERAL TECH

17. APFT

2-MILE RUN

APFT

APFT

 

 

(Enter as YYMMDD)

 

DATE (Enter as YYMMDD)

 

 

 

 

(GT) SCORE

 

PUSH UPS SIT UPS

MIN SEC

SUM

PASS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

14c. IF DATE SPECIFIED IS A REENLISTMENT DATE, INDICATE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

PERIOD OF ORIGINAL ENLISTMENT (Enter as YYMMDD)

 

18.

CIVIL CONVICTIONS

19a. FAVORABLE SECURITY

 

19b. WHAT TYPE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

CLEARANCE COMPLETED

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

20.

NAME OF COLLEGE OR UNIVERSITY YOU WILL BE

21. SCHOOL CODE

 

ATTENDING

 

 

 

 

 

 

22.

IF ITEM 20 DOES NOT HOST ARMY ROTC, INDICATE

23. SCHOOL CODE

 

THE SCHOOL WHERE YOU WILL TAKE ROTC

 

 

 

 

 

 

24.

RESIDENT

25.

ACADEMIC MAJOR

 

STUDENT STATUS

 

CODE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

26.

SCHOLARSHIP TYPE

27. Are you interested in the Green to Gold Active Duty

(Masters=M, 2-Yr=2, 3-Yr=3, 4-Yr=4)

Option Program to obtain your commission (2-Yr only)?

 

 

 

 

 

 

YES

 

 

NO

 

 

 

 

 

 

 

 

 

 

 

 

 

 

28.

LIST AWARDS, DECORATIONS OR SPECIAL RECOGNITION BESTOWED UPON APPLICANT WHILE ON ACTIVE DUTY

 

 

 

 

 

 

 

29.

EMAIL ADDRESS OF APPLICANT

 

 

30. FAX NUMBER OF APPLICANT

 

 

 

 

 

 

 

 

 

 

 

 

 

 

31.

SIGNATURE OF APPLICANT

DATE

32. VERIFICATION AND SIGNATURE BY THE MILPO OFFICE (INCLUDE RANK)

DATE

 

 

 

 

 

 

 

 

CC FORM 173-R, NOV 03

REPLACES ROTC CADET COMMAND FORM 173-R, DTD AUG 01

Page 1 of 2

Cc Form 173 R isn’t the one you’re looking for?

Related Documents