NROTC Scholarship Application
Minority Serving Institution Scholarship Reservation
(MSISR)
Applicant Information:
Applicant Name:
Name: Applicant
____________________________
SSN:
(Please put SSN on every page in spot indicated)
SSN:
_____________________________
Applicant Birth
Date:
Date
of Birth: school
________________________
year
For academic
starting in September:
______ 2010
_______ 2011
_______ 2012
___________________________
Applicant
Contact Information:
___________________________
Address:
Address:
____________________________________
BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
____________________________________
Primary
_____________________
Primary Telephone:
#: ____________________________________
BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
Alternate #: ____________________________________
Alternate
Telephone:
BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
Email:
____________________________________
Email:
____________________
____________________________
BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB
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For Academic
School year starting September, 20__
15
Candidate Guidance Office Contact Information:
Candidate
Guidance
Office
Contact
Information:
1.800.NAV.ROTC
ext
27272,
22356, 22929,
or 22173
[email protected]
800-NAV-ROTC
(800-628-7682)
ext 27272
or email [email protected]
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NROTC Interests
Please indicate the MSI College or University you wish to attend. In addition to this scholarship
application, you are also responsible for applying to and being accepted by that institution. If
you are awarded a scholarship, you will be responsible for enrolling in that institution in order
to activate the scholarship.
Minority Serving Institutions
Historically Black Colleges & Universities
Allen University
Clark Atlanta University
Dillard University
Florida A&M University
Hampton University
Howard University
Huston-Tillotson College
Morehouse College
Norfolk State University
Prairie View A&M Univ.
Savannah State University
Southern University and A&M College
Spelman College
Tennessee State University
Texas Southern University
Tuskegee University
Xavier University
High Hispanic Enrollment
Central New Mexico Community College
Pima Community College
University of New Mexico
Other MI (not HHE/HBCU)
Kennedy King College
-- SELECT ONE -Minority Institution you would like to attend: _______________________________
Allen University
Major course of study you would like to pursue at that school: ________________
______________________________________________________________________
A reminder: the Navy awards 85% of scholarship opportunities to individuals who are pursuing Tier 1
and Tier 2 technical majors.
For Official Use Only – Privacy Sensitive: Any misuse or unauthorized disclosure may result in both civil
and criminal penalties.
Page 23 of 27
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