On this page are all the forms that you need to enroll and contract with the Jackson State University Army ROTC program. Click on a link to download the appropriate form. The forms are in .xls (Microsoft Excel Spreadsheet), .pdf (Adobe Acrobat Document), or .doc (Microsoft Word Document), which can be opened with software freely available on the Internet, such as Open Office and Adobe Acrobat.
NOTE: If you’re having trouble opening a PDF file in the browser, save the file to your computer and open with Adobe Reader.
These are the documents needed to contract with JSU Army ROTC. For any questions, contact Mr. Rodney Hall, Recruiting Operations Officer.

Scholarship Contracting PAK 2020
Non-Scholarship Contracting PAK 2020

Basic Enrollment Forms
CC Form 136-R, Briefing on Government Sponsored Benefits for ROTC Cadets
CC Form 137-R, Authorization/Declination for Access to Student Records
CC Form 139-R, Cadet Enrollment Record
CC Form 104-R, Planned Academic Worksheet
DD Form 2005, Privacy Act Statement – Health Care Records

Additional Requirements
DD Form 2351, DoDMERB Report of Medical Examination
DD Form 2492, DoDMERB Report of Medical History
DA Form 705, Army Physical Fitness Test Scorecard
Fast Start Form (007)
145-4-1 Consent and Release 3-31-15
Transcripts (Unofficial, must show cumulative GPA)
Birth Certificate
Social Security Card
Shots and Immunizations Records

Finance Forms
SF 1199A Direct Deposit Form
W4 (Most recent)
DD Form 2058, State of Legal Residence Certificate
DD Form 93, Record of Emergency Data
SGLV 8286 SGLI Election Certificate

SMP/National Guard Only
DD Form 4 Enlistment Contract
DD Form 214/DD Form 220
NGB Form 594-1 SMP Agreement ARNG
DA Form 4824-R Addendum to Certificate and Acknowledgement of Service Requirements for all US Army Reserve Personnel Applying for Participation in ROTC SMP

Miscellaneous Forms/References
Basic Camp Handbook
Advanced Camp Handbook
DA Form 31, Request and Authority for Leave

Contact Us!

4th Floor, College of Liberal Arts
1400 John R. Lynch Street PO Box 17569 Jackson, MS 39217-0369
PHONE: (601) 979-8600 FAX: (601) 979-9870 EMAIL:

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For more information on joining the Tiger Battalion, text "NG70" to 462769 or fill out our information form today! JSU Army ROTC Interest Form  Visit Us on Facebook  Visit Us on Twitter