Nrotc App

NROTC Application For:
Romeo, Bonnie
SSN:
XXX-XX-7875
Program Applying For:

X
NROTC Navy Option

NROTC Marine Corps Option
NROTC Nurse Corps Option
Applicant Contact Information:

Address:
24680 NW Dixie Mountain Road

North Plains, OR 97133
Primary #:
5036216953
Alternate #: 5033300310
Email:
bonnie.romeo2@gmail.com
Coordinator/Recruiter Contact Information:

Recruiter Name:
Petty Officer Willie James Herron Jr
Title:
NROTC Coordinator
Address:
1220 SW 3rd Ave suite 200, Portland, OR 97204
Phone:
503-258-2058 / 512-484-6770
Cell:
512-484-6770
Email:
willie.herron@navy.mil
SSN:
XXX-XX-7875
Personal
Name and Address
First Name:
Bonnie
Middle Name:
Lucille
Last Name:
Romeo
Suffix:
Gender:
Male
Female
Permanent Address:
Street:
24680 NW Dixie Mountain Road
City:
North Plains
County:
State:
OR
Zip Code:
97133
Country:
United States
Remarks if Country not US
If your permanent address or phone number are outside the United States, please explain below
Yes
Do you have a different mailing address?
No
Mailing Address (If different from permanent address)

Street:
City:
State:
Zip Code:
Primary Phone Number: (i.e. 999-999-9999)
5036216953
Alternate Phone Number:(i.e. 999-999-9999)
5033300310
Email Address:
bonnie.romeo2@gmail.com
Citizenship
Place of Birth:
Hillsboro, OR
Are you a U.S. Citizen?
Yes
No
For Official Use Only - Privacy Sensitive: Any misuse or unauthorized disclosure may result in both civil
and criminal penalties
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SSN:
XXX-XX-7875
Naturalization
How citizenship was obtained?
Birth
If a Naturalized Citizen, or born outside of the United States, of American parents, submit proof of
citizenship - See Instructions to Candidates
If you hold citizenship in any other country(ies) other than the United States
please specify here and briefly explain in remarks section: (Required if US
Citizenship is No)
Yes
No
If yes, please specify countr(ies)

Other Citizenship Remarks
State of Legal Residence:
OR
Languages
Do you possess a language proficiency other than English?
Yes
No
Please specify most proficient language:

Other Languages:
How did you obtain your proficiency?
Civilian School
Defense Language Institute (DLI)
Foreign Residence
Military School other than DLI
Home
How proficient are you?
Self-Study
Fluent (speak and understand virtually all types of conversations)
Limited (speak and/or understand most general conversations with limited difficulty)
Elementary (speak and understand basic greetings and memorized phrases)
Language Remarks (If more than one, please note the most proficient)
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SSN:
XXX-XX-7875
Race and Ethnicity

RACE
(you may select upto 5)
American Indian/Alaskan Native

Asian
African American/Black
Native Hawaiian/Other Pacific Islander
X Caucasian
Ethnic Background (optional)
Aleut
Korean
Polynesian
Chinese
Latin American w/Hispanic Decscent
Puerto Rican
Cuban
Melanesian
U.S./Canadian Indian Tribes
Eskimo
Mexican
Vietnamese
Filipino
Micronesian
Other
Guamanian
Other Asian Descent
None
Indian
Other Hispanic Descent
Did not respond
Japanese
Other Pacific Island Descent
Ethnic Remarks
Personal Information
How did you hear about the NROTC Program?
NROTC Coordinator contacted me

X
NROTC Coordinator school presentation

MEPS Talked to me about it while signing contract
Coordinator/Recruiter Gave me information
Received NROTC mail out
NAVY.COM website
Received Email
Other source
Other source Remarks:
IF REFERRED BY A RECRUITER OR NROTC COORDINATOR, WHAT IS HIS/HER NAME?
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SSN:
XXX-XX-7875
Height (in inches)
62
Weight (in pounds)
130
Have you ever been arrested, convicted, or fined for any violation of law?
Yes
No
Give complete description of incident(s) and if applicable state name and place of court, nature of offense,
date and disposition of case (If selected as a cadet/midshipman, in order to grant a Security Clearance, a
complete background investigation will be made. Failure to report any such incident may be grounds for
dismissal).
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SSN:
XXX-XX-7875
References
Please supply the name and address of your counselor who will be completing your transcript and overall
academic performance information.
Name:
Michelle Kim
School Name:
Liberty High School
Address:
21945 NW Wagon Way
City:
Hillsboro
Phone Number:
5038441250
Email Address:
kimm@hsd.k12.or.us
State: OR
Zip Code:
97124
Please supply the name and address of your teacher who will be completing your Math evaluation.
Name:
Milton Scholl
School Name:
Liberty High School
Address:
21945 NW Wagon Way
City:
Hillsboro
Phone Number:
5038441250
Email Address:
schollm@hsd.k12.or.us
State: OR
Zip Code:
97124
Please supply the name and address of your Teacher, Counselor, Coach, or Employer who will be completing
your other evaluation.
Name:
Ramona Toth (Teacher)
School Name:
Liberty High School
Address:
21945 NW Wagon Way
City:
Hillsboro
Phone Number:
503844
Email Address:
tothr@hsd.k12.or.us
State: OR
Zip Code:
97124
List Sport if Coach, Business if Employer or Subject if Teacher:

Health Sciences
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SSN:
XXX-XX-7875
Education
Were you home schooled?
Yes
Liberty High School

Hillsboro, OR
19
Rank in Class
No
06/17
High School Graduation Date

Name of High School:
Number of Students in Class
372
School Data
List in chronological order all schools attended since eighth grade, Identify schools and addresses
completely. Ensure that transcripts of your academic record for all high schools, preparatory
schools and colleges you attended, wether or not credit was earned, have been forwarded by the
school or college registrar to the recruiting activity processing your application.
NAMES AND ADDRESSES OF SCHOOLS ATTENDED
High Schools (If you did not

complete H.S. indicate
Liberty High School

Hillsboro, OR
DATE OF
ENTRY
(MM/YY)
DATE OF
DEPARTURE
(MM/YY)
DATE OF GRAD
(MM/YY)
09/13
06/17
06/17
reason in remarks section)
Current Studies:
Please list the names of courses in progress or planned for completion during the senior year. (High School
graduates provide college course name if applicable.)
FIRST TERM
SECOND TERM
AP Chemistry
AP Chemistry
AP Government
AP Government
AP Literature
AP Literature
AP Calculus
AP Calculus
Health Sciences 2
Health Sciences 2
Leadership 2
Leadership 2
Peer Tutoring
Peer Tutoring
AP Government
AP Government
Have you ever been placed on suspension, probation or expelled from high
school, college, civilian preparatory school or any other academic institution?
ADDITIONAL TERMS (If appropriate)
Yes
No
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SSN:
XXX-XX-7875
If yes, complete the following

Date:
Name of School:
Address of School:
City:
State ZipCode:
Reason:
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SSN:
XXX-XX-7875
Test Scores
List all ACT/SAT scores with test dates from Dec '14 to Dec '16
Only SAT/ACT scores from Dec '14 to Dec '16 will be considered for the 2017 scholarship year.
Navy/Nurse Corps Options: For selection board purposes, you will be evaluated based on the highest
scores in each category if you elect to take these tests multiple times.
Marine Option: The SAT math and critical reading scores must be from the same and most recent test.
Applicants cannot combine their best math and critical reading scores from the SAT to achieve the
qualifying score for application.
You must contact the ACT/SAT Board and release the test score(s) to Navy ROTC (Code 0656) and
you need provide an official copy of your scores to your recruiter.
ACT - Enter ENGLISH, MATH and COMPOSITE scores.

SAT - Enter CRITICAL READING, MATH and Combined READING + MATH scores ONLY.
Test Date
Test Type
English/Critical
Reading
Math
Composite
10/2016
SAT
610
650
1260
05/2016
SAT
600
530
1130
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SSN:
XXX-XX-7875
Military
Have you previously attended or are you currently attending the Air Force,
the Naval, or the Military Academy Preparatory School or the Navy Boost
School?
Yes
No

School:
BOOST
USNA Prep
USAFA Prep/ USMA Prep
Status:
Currently Attending
Completed
Did Not Complete
Completion Date:
Are you currently in the Delayed Entry Program (DEP)?
Yes
No
Are you currently in the College Program for NROTC?
Yes
No
Have you ever served tours of extended active duty drawing full pay, from
which you were discharged or separated to civilian status?
Yes
No
Are you now on active duty in the U.S. Armed Forces drawing full pay?
Yes
No
If yes, what unit?
If yes to either question above, complete the following

Regular
Reserve
Branch of Service:
Grade / Rank:
Organization and Location:
Dates of Active Duty: From (MM/YY)
TO (MM/YY)
Dates and Type of Discharge or Separation: DATE (MM/YY)

Are you currently a member of a U.S. Reserve or National Guard
Organization?
TYPE
Yes
No

Branch of Service:
Grade / Rank:
Active
Inactive
Organization and Location:

Date Tour Started (MM/YY)
Have you ever been rejected for any branch of the military service or ROTC?
Yes
No
If yes, please explain:
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SSN:
XXX-XX-7875
Have you ever been a Cadet/Midshipman at any of the U.S. Service

academies or ROTC Programs?
Which Academy/ROTC Program
Yes
No
AROTC
AFROTC
USNA
USCGA
NROTC
USMA
USAFA
USMMA
To (MM/YY)
Dates of attendance From (MM//YY):

Reason for departure:
Are you currently an applicant or do you intend to apply for a service

academy or ROTC Program?
Yes
No
If yes, which Academy/ROTC Program

X
AROTC
AFROTC
USNA
USCGA
NROTC
USMA
USAFA
USMMA
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SSN:
XXX-XX-7875
Family
Father
Relationship Type:
Father
Name:
X
Same Permanent address as you?

Deceased?:
Mark K. Romeo
Yes
No
X
Yes
No
Mailing Address:
Street:
City:
State Zip Code:
Technical Support Manager
Occupation:
Did he serve in the military?
Yes
No
BRANCH OF SERVICE
CURRENT DISPOSITION
DUTY STATUS
RANK/RATE
ARMY
DISCHARGED
REGULAR STATUS
CAPTAIN/O3
Did your father die serving on Active Duty?

Was your Father a graduate of any U.S.
Service academy or ROTC Program ?
Yes
No
Yes
No

AROTC
X
NROTC
Year Graduated:
AFROTC
USNA
USCGA
USMA
USAFA
USMMA
87
What is your father's highest level of education?
GRADE SCHOOL
HIGH SCHOOL
SOME SCHOOL
ASSOCIATES DEGREE
BACHELORS DEGREE
X
GRADUATE OR PROFESSIONAL DEGREE

UNKNOWN
DECLINE TO RESPOND
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SSN:
XXX-XX-7875
Mother
Relationship Type:
Mother
Name:
X
Same Permanent address as you?

Deceased?:
Kathleen M. Romeo
Yes
No
X
Yes
No
Mailing Address:
Street:
City:
State Zip Code:
Occupation:
Property Manager
Did she serve in the military?
Yes
BRANCH OF SERVICE
No
CURRENT DISPOSITION
Did your mother die serving on Active Duty?
Yes
Was your mother a gradutate of any U.S.

Service Academy or ROTC Program?
Yes
DUTY STATUS
RANK/RATE
No
X
No

AROTC
AFROTC
USNA
USCGA
NROTC
USMA
USAFA
USMMA
Year Graduated:
What is your mother's highest level of education?
GRADE SCHOOL
HIGH SCHOOL
SOME SCHOOL
ASSOCIATES DEGREE
BACHELORS DEGREE
X
GRADUATE OR PROFESSIONAL DEGREE

UNKNOWN
DECLINE TO RESPOND
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SSN:
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Brother/Sister
Have you had or do you have a Brother/Sister at a
service academy or ROTC Program?
Yes
No

AROTC
AFROTC
USNA
USCGA
NROTC
USMA
USAFA
USMMA
YEAR GRADUATED
Did they graduate?
Have any of your brothers or sisters attended college?
If yes, did any of them obtain a degree?
Yes
Yes
Yes
No
X
No
No
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Employment
Volunteer Activities
VOLUNTEER WORK (Explain in remarks)
GRADE
10
11
12
55
55
85
70
Hospital/Candy Striper
With Handicapped Elderly
Tutor / Coach Children
Other
Total Volunteer Hours Per Year
Volunteer Work Remarks:
Volunteer Bull Pen Organizer and Race Starter, Hillsboro School District Middle School Track Meets 9, 10,11, &
12 Hillsboro Parks and Recreation Track Club Volunteer Coach 12 Hillsboro Parks and Recreation All-Comers
Track Meet Volunteer Official 12 Mt. Hood Soccer Tournament, Concessions Volunteer 10 &11 Les Schwab
Invitational Basketball Tournament, Concessions Volunteer 9, 10, & 11 Oregon State Soccer High School
Championship Tournament, Ball Girl 10 Oregon Marathon, Water Table Volunteer 11 &12 Oregon Fall Half
Marathon, Check-in Volunteer and Water Table Volunteer 11 Hillsboro School District Elementary Schools,
Student Vision Screening Volunteer 11
Employment
If you worked on school days during the entire year, either at a paying or non-paying job, or on a farm, indicate the
grade you were in and the average number of hours worked each week.
GRADE
9
10
11
12
Average Hours Per Week
Indicate the reason for work in space below:
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Work Responsibilities
Assigned responsibilty to open or close business
Yes
No
Worked as a shift Supervisor or Manager
Yes
No
Assigned responsibility to train new employees
Yes
No
Other (Explain in remarks section below)
Yes
No
Work Responsibility Remarks (Limit to 5000 characters):
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Activities
Athletic Activities
Activities could include those not associated with high school, i.e. community leagues, traveling or competitive
teams, mountain/bmx/dirt biking, triathlon, marathons, ironman etc. Explain in remarks section to include number
of hours per week.
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SSN:
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Jr. Varsity,
American
Legion, Babe
Ruth, etc.(not
intramurals)
Varsiity
School
Teams
A
ACTIVITY/GRADE
10
Varsity
Letters
Earned
B
11
12
Team Captain
OR
Co-Captain
10
11
12
All State/
District/
City Or County
(1st Team only)
(Explain in remarks)
10
11
12
10
E
11
12
10
11
12
TEAM COACH, MANAGER OR

TRAINER
BASEBALL/SOFTBALL
BASKETBALL
CREW/ROWING
CROSS COUNTRY
EQUESTRIAN
FOOTBALL
GOLF
GYMNASTICS/COMPETITIVE
DANCE/CHEERLEADING
HOCKEY(FIELD OR ICE)
JUDO, KARATE OR OTHER MARTIAL
ARTS
LACROSSE
RIFLE/PISTOL
RUGBY
SAILING
SKIING
SOCCER
SWIMMING/DIVING
TENNIS
TRACK (Indoor/Outdoor)
VOLLEYBALL
WATER POLO
WEIGHTLIFTING/POWERLIFTING
WRESTLING
OTHER*(EXPLAIN IN REMARKS)
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SSN:
XXX-XX-7875
Remarks (Limit to 5000 characters):
Have competed in the State Track & Field Meet for the 4x100 relay (2014, placed 6th as a relay and 2nd as a
team in overall scores), 300 hurdles (2015, placed 8th, & 2016), and the 4x400 relay (2015, placed 5th & 2016,
placed
6th).
Fair
Poor
Strong
How
well
do you swim:
X
How often do you swim:
Once a month or less
3 to 5 times a month
More than 5 times a month
Non-Athletic Activities
Indicate your participation:
Boy Scouts of America

Member
Eagle
Sr. Patrol Leader
Girl Scouts of America
Member
Gold Award Recipient
Troop Officer
Camp Fire Girls
Horizon Club Member
Camp Counselor
Rep Regional Meetings
Rainbow Girls
Member
Officer
Grand/Supreme Leader
Explorer Scouts
Member
Troop Officer
Silver Awards
(Remember, if you are an officer

you are also a member)
Non-Athletic Activities Remarks:
Total hours per month in these activities:
School Offices:
SCHOOL OFFICERS
GRADE
STUDENT BODY/
COUNCIL / GOVERNMENT
9
10
11
12
CLASS
10
11
12
SCHOOL CLUB
11
10
12
President/Chairperson
Vice President
Secretary/Treasurer
Representative/Committee
Chairperson
X
X
School Officer's Remarks:
25
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SSN:
XXX-XX-7875
School Publications:
Grade
10
11
12
Editor In Chief
Business Circulation or Advertising Manager
Feature, Sports, News, or Photo Editor
Writer-Reporter or other Staff Member
School Publication Remarks:
School Organizations:
School Organizations
(Remember, if you are an officer, you are also a member)
Boy's/Girl's Nation
President
Vice President
Delegate
Boy's/Girl's State
Governor
Lt. Governor
Delegate
National Honor Society
President
Vice President
Beta Club
President
Vice President
Member
Member
School Organizations Remarks:
Have been a National Honor Society member, and was the 2015-2016 secretary.
2
Awards & Honors:

AWARDS AND HONORS
SPECIFY NUMBER OF AWARDS RECEIVED
Local Academic Awards

(explain in remarks section)
Local Citizenship Awards
Local Sports Awards
State or National Awards
3 or more
3 or more
3 or more
3 or more
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XXX-XX-7875
SSN:
Awards & Honors Remarks:
Multiple all league athlete in Track & Field for being one of the best in my event.
Selected to attend Summer Leaders Experience at West Point in Spring of 2016
Music Participation:
Chorus
Orchestra
9
Grade
10
11
12
10
Band
11
12
10
11
12
Director, Leader, or Drum Major

Member
Remarks:
Other Activities:
Grade
10
11
12
Participation in Competitive, Dramatic, or Humurous Reading

Participation in contest one-act plays
Participation as an actor/actress, stage manager, or student
director in a 3 act play before a public audience
Drill Team/ Color Guard
CheerLeader/ Pom Pom
4H Club Judge
4H Club Member
DECA
Active member of Sailing Association
Junior Achievement
President
Vice
President
President
Vice
President
Church Group
Member
X
Member
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Remarks:
JROTC / CAP / Sea Cadets

Grade
10
11
12
Sea Cadet Member

JROTC CAP Member (High School Only)
JROTC/Sea Cadet/CAP Petty Officer/Officer/Non-Commissioned
Officer
If in JROTC or CAP, which branch?
NAVY
AIR
FORCE
MARINE
ARMY
CIVIL AIR
PATROL
COAST
GUARD
Remarks: (List billets held and number of cadets you were in charge of)
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Other Accomplishments:
Have private pilot license
Yes
No
Have radio operator's license
Yes
No
Have open water scuba license
Yes
No
Foreign Exchange Student
Yes
No
If Yes on Foreign Exchange Student: Country:
N/A
Length of Time:
CPR Certified Instructor
Yes
No
Certified Lifeguard
Yes
No
Certified Water Safety Instructor
Yes
No
Paramedic
Yes
No
Volunteer Firefighter
Yes
No
Certified Nursing Assistant (CNA)
Yes
No
Emergency Medical Technician (EMT)
Yes
No
Other (Explain in remarks)
Yes
No
N/A
Remarks: List accomplishments not found on this form which involved responsibility and leadership or are
otherwise noteworthy, or reason for limited participation in athletics or extracurricular activities (Limit to
5000 characters)
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NROTC Interests
Are you interested in pursuing a scholarship in the NROTC Language Regional Expertise and Culture (LREC)
Program?
Yes
No
Region:
Language:
If you are not selected for the 4-year National Scholarship would you be interested in an equivalent scholarship to a
Minority Serving Institution/?
Yes
No
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Enter college or university you wish to attend if selected for a scholarship. You must select five (5) schools and
you must inidicate whether or not you qualify for in-state tuition for each of you choices. Additionally, one of you r
top three choices must be a state/public institution (indicated by *) where you qualify for in-state tuition. If this is
not possible you must provide an explanation for why you cannot qualify for the in-state tiution rate at any one of
the NROTC units located at state/public schools. Do not include service academies. Indicate how strongly you
feel about attending your first choice school in the strength of preference below.
CHOICE
UNIT NO.
1ST
035
Oregon State University
INSTITUTION
Qual for In-State Tuition
Yes
2ND
086
San Diego State University
Yes
No
3RD
054
University of Washington
Yes
No
4TH
005
University of Colorado
Yes
No
5TH
025
University of Mississippi
Yes
No
No
You are still responsible for applying to and being accepted for admission to the college and universities that you
select. College choices are used for placement at a particular NROTC unit only. Placement at a unit does not
guarantee you admission to that college. We strongly suggest that you apply to all five of your listed choices. If
selected for a scholarship, it will be for one specific school and may be used at any other school affiliated with the
unit's host school. You must apply to, be accepted at, and enroll in your assigned school in order to utilize the
scholarship. Applying to all five of the choices will increase the chances for acceptance and enrollment and will
therefore increase the opportunities to use a scholarship if selected.
Applications will not be reviewed unless five NROTC units are selected. Unit assignment for a scholarship is
based on the needs of the Navy and may or may not be your first choice.
Please check here to acknowledge
DATE:
11/2/2016
Indicate the reason why you cannot qualify for in-state tuition at one public/state unit school.
Strength of preference for 1st choice school
Will go to any NROTC school if awarded scholarship

X
Prefer 1st choice but wouldn't mind attending 2nd through 5th choice schools
Will accept scholarship only if assigned to first choice school
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Why did you choose these schools?
I want to stay on the west coast or close to family, and these schools offer a wide variety of programs I am
interested in.
Indicate the major you intend to pursue at you first choice school.
Biology
What have you done to prepare for this major?
I have taken multiple AP science classes, and I have been a part of my school s Health Sciences department
for two years. I have had the opportunity to explore opportunities in the medical field. Biology will prepare me
for a health career.
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Essays
INSTRUCTIONS: Compose your own responses. (Limited to 2500 characters )
Required
Discuss your reasons for wanting to become a Naval Officer. Specifically comment on leadership positions
you've held, the challenges you have faced and the lessons you have learned. (Limited to 2500 characters)
My interest in the Navy began as a freshman. A fellow track athlete at my school was set to attend the USNA. During
the season, I spent time learning about her and why she wanted to join the Navy. Our deep and thoughtful
conversations sparked an interest in me about the Navy. Last spring, I took a week off of school to attend West
Points Summer Leadership Experience. Living life as a cadet for a week, I realized that a service academy was the
not the exact college experience I desired, yet I still wanted a career as a military officer. NROTC can give me a
college experience while also preparing me to be a military leader. I have held many leadership experiences in school .
I have been involved in our leadership organization at school all four years. I was captain of my JV basketball team
and a captain for my track team last year. I coached youth basketball and track last summer, and I have served as a
basketball camp counselor for the last three years. I know NROTC life can be challenging, but I feel that my personal
experiences have prepared me. As a sophomore, with a 4.0 GPA, I decided to challenge myself and signed up for AP
European History. This class proved to be the biggest challenge and hardest to date. For the first major test, I studied
normally. However, I failed the test. I was forced to look deep within myself and face the cold, hard truth that I was
not infallible. I was, however, determined to not only thoroughly learn the material, but to effectively demonstrate my
knowledge through tests and essays. I redoubled my efforts and earned a B in the class. I came out of the class with
new additions to my character including humility, self -realization, and unrelenting determination. I also learned what it
means to be truthful to ones self and face facts of less than ideal situations. Even though it cost me my 4.0 GPA, I
wouldnt trade this experience for anything. I feel it has prepared me to tackle the challenges of the NROTC.
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SSN:
XXX-XX-7875
What do you do to maintain or improve your physical fitness?
What do you do to maintain or improve your physical fitness? 1000c

Being physically active and fit are key pieces in my life, and I often find myself planning my schedule around practices
and going to the gym. To maintain my fitness, I run cross country and track along with playing varsity basketball for
my school. I push myself hard in running practices, and I race against the clock as I strive to improve each race. I
Duringthat
a typical
how many
you spend:
know
I may school
not beweek
the fastest
one hours
on thedocourse,
but as long as I improve and continue to set personal records, I
consider it a win . I know that with determination, I may be of the leaders of the race one day. I also go to the gym to
35
improve
At school:
my strength. I enjoy lifting weights and challenging myself
by adding on weight to machines, which will build
my strength and enable me to be ready for a future in the Navy. I am continuing to work on maintaining my stamina by
10
Doing homework:
running
and playing basketball, and I continue to lift weights to improve my strength.
Engaged in athletic team activities:
15
Engaged in extra-curricular activities (i.e. clubs):
Engaged in volunteer activities:
Other (explain):
If hours are entered in Other section enter remarks here:
Which unrestricted line community do you wish to commission into and why?
Surface Warfare:
Naval Aviator (Pilot):
Naval Flight Officer (Aviator):
Submarine Officer:
Explosive Ordnance Disposal Officer:
Special Warfare Officer:

Why did you choose this option?
My father was an Army EOD technician and was commander at the 70th Ordnance EOD Detachment at the Naval
Submarine Base in San Diego. He has talked to me often about what he used to do, much of which involves creating
a safe environment and eliminating unsafe unexploded ordnance. He explained to me some of the technical aspects of
bombs, which intrigued me. While stationed in San Diego, he also told me about the EOD dolphins that the Navy
EOD works with, and I really believe in this mission. I would like to commission into this area because the technical
aspect appeals to me as well as the personal satisfaction I would get from helping people keep safe from dangerous
ordnance.
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NROTC Application For:

Program Applying For:

NROTC Navy Option

Applicant Contact Information:

24680 NW Dixie Mountain Road

Coordinator/Recruiter Contact Information:

Petty Officer Willie James Herron Jr

1220 SW 3rd Ave suite 200, Portland, OR 97204

24680 NW Dixie Mountain Road

Remarks if Country not US

Do you have a different mailing address?

Mailing Address (If different from permanent address)

Alternate Phone Number:(i.e. 999-999-9999)

Are you a U.S. Citizen?

How citizenship was obtained?

If yes, please specify countr(ies)

State of Legal Residence:

Please specify most proficient language:

How proficient are you?

Race and Ethnicity

American Indian/Alaskan Native

Ethnic Background (optional)

Latin American w/Hispanic Decscent

U.S./Canadian Indian Tribes

Other Asian Descent

Other Hispanic Descent

Did not respond

Other Pacific Island Descent

How did you hear about the NROTC Program?

NROTC Coordinator contacted me

NROTC Coordinator school presentation

Other source Remarks:

IF REFERRED BY A RECRUITER OR NROTC COORDINATOR, WHAT IS HIS/HER NAME?

Height (in inches)

Weight (in pounds)

Liberty High School

21945 NW Wagon Way

Liberty High School

21945 NW Wagon Way

Ramona Toth (Teacher)

Liberty High School

21945 NW Wagon Way

List Sport if Coach, Business if Employer or Subject if Teacher:

Liberty High School

High School Graduation Date

Number of Students in Class

High Schools (If you did not

Liberty High School

reason in remarks section)

ADDITIONAL TERMS (If appropriate)

If yes, complete the following

ACT - Enter ENGLISH, MATH and COMPOSITE scores.

If yes, complete the following

USAFA Prep/ USMA Prep

Did Not Complete

Are you currently in the Delayed Entry Program (DEP)?

Are you currently in the College Program for NROTC?

If yes, what unit?

If yes to either question above, complete the following

Dates and Type of Discharge or Separation: DATE (MM/YY)

If yes, complete the following

Organization and Location:

If yes, please explain: