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OFFICER CANDIDATE SCHOOL APPLICATION

1. NAME (Last, First, Middle)

2. GRADE

3. SSN

4. GENDER

_____MALE _____FEMALE

5. ORGANIZATION (Include Address & Zip Code)				6. UNIT PHONE

7. HOME OF RECORD (Street, City, State & Zip Code)				8. HOME PHONE

9. EMPLOYER (Include Address & Zip Code)				10. EMPLOYER PHONE

11. DOB / AGE	12. ARE YOU A U. S. CITIZEN:			IF NO, DATE OF CITIZENSHIP APPLICATION:
_______________ / ____________	_____YES ______ NO				___________________________

13. WAIVER(S) REQUIRED:	14. DO YOU HAVE A CHAPTER II			15. DO YOU HAVE A "SECRET" CLEARANCE:
_____YES ______NO	PHYSICAL WITHIN SIX MONTHS			____ YES _____ NO
	OF CLASS START DATE:
IF YES, ATTACH COPY (COPIES)	_____ YES ______ NO			IF NO, DATE REQUESTED: _________________

16. COLLEGE DEGREE: _____YES _____NO		LEVEL OF DEGREE: _____ AA _____ AS _____ BA _____ BS
IF NO DEGREE, NUMBER OF COLLEGE CREDITS: ________		TYPE OF CREDITS: _______ QUARTER (or) _______ SEMESTER

NAME OF COLLEGE: (Include Address, City, State & Zip Code)		FRESHMAN	_______		Complete if credits earned are less than
		SOPHOMORE	_______		60 semester hours.
		JUNIOR	_______		SAT (850) MINIMUM __________
		SENIOR	_______		ACT (19) MINIMUM __________
					__________

17. MILITARY BACKGROUND:

PEBD : ________________

ETS DATE: (Must be 16 months from Class Start Date) _______________

PRIMARY MOS: ________________________________________

DATE OF MN ARNG ENLISTMENT: ______________________________

HIGHEST LEVEL OF MILITARY EDUCATION: ____________

TOTAL YEARS OF MILITARY SERVICE: _________________________

GT SCORE: (110 MINIMUM) :______________________________

18. LAST APFT SCORE: PU _______ SU _______	RUN ______ TOTAL: _________ DATE OF TEST: ______________________________
LAST SEMI ANNUAL WEIGH-IN: HEIGHT IN INCHES _________ WEIGHT _________ DATE_____________________
PASSED SCREENING WEIGHT _______ YES	_______ NO IF OVER SCREENING WEIGHT, PERCENT OF BODY FAT __________%

(Attach DA Form 5500 for Males, DA Form 5501 for Females.)

19. WERE YOU EVER REJECTED FOR MILITARY SERVICE OR APPOINTMENT AS AN OFFICER? _______ YES _______ NO

WERE YOU EVER COURT-MARTIALED? ________ YES ________ NO

DID A CIVIL COURT FOR OTHER THAN MINOR TRAFFIC VIOLATIONS EVER CONVICT YOU? _______ YES _______ NO

(If YES, attach statements of circumstances.)

20.UNIT COMMANDER'S STATEMENT OF APPLICANT'S LEADERSHIP POTENTIAL: __________________________________________

_____________________________________________________________________________________________________________________________

_______________________________________	________________	___________________________________	________________
SIGNATURE OF APPLICANT	(DATE)	SIGNATURE OF UNIT COMMANDER	(DATE)

RTI Form 351a, 1 August 1998 (LRA)

All previous editions of OCS Applications are SUPERSEDED.

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21.OFFICER CANDIDATE SELECTION BOARD COMMENTS:

_____________________________________________________________________________________________________________________________

IT IS THE OPINION OF THE OFFICER CANDIDATE SELECTION BOARD THAT _______________________________________________

(SHOULD) / (SHOULD NOT) BE APPOINTED AS AN OFFICER CANDIDATE IN THE STATE RTI OFFICER CANDIDATE SCHOOL CLASS #___________.

_______________________________________________	____________________________________	_____________
TYPED RANK AND NAME OF BOARD PRESIDENT	SIGNATURE OF BOARD PRESIDENT	DATE
_____________________________________________	____________________________________	_____________
TYPED RANK AND NAME OF BOARD MEMBER	SIGNATURE OF BOARD MEMBER	DATE
_____________________________________________	_____________________________________	_____________
TYPED RANK AND NAME OF BOARD MEMBER	SIGNATURE OF BOARD MEMBER	DATE

RTI Form 351a, 1 August 1998 (LRA)

All previous editions of OCS Applications are SUPERSEDED.

PAGE 2 OF 2 PAGES

Rti Form 351A – Fill Out and Use This PDF