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Which Services Are You Interested In?
US National Guard     US Navy     US Army      
US Marines      
US Coast Guard      

Do you have prior Military service? Yes No

First Name:

Last Name:
Street Address:

Street Address 2:(optional)

Zip Code:
Date of Birth:
Home Phone: - -
Mobile Phone: - - (optional)
Email Address:
Yes! I would like to learn more about receiving a higher education.
Please send me infomation.
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Please tell us a little about yourself.

What is the highest level of school you have completed?
High School:
 9     10     11     12   
 1     2     3     4     4+ years
What is your high school graduation date?(optional)
What is Your Gender?
Male Female
What is your U.S. citizenship status? 
U.S. Citizen Legal Resident Neither
What is your ethnic background? 
Asian Black/African American Latino/Hispanic
Native American White/Caucasian Other
Career of Interest:

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Collection of information is authorized by Title 5 U.S.C. 301, Departmental Regulations, and E.O. 9397. For official use only when filled in. is not and does not represent DOD in any way. is a private company that provides job/career information at no cost to interested prospects.


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