Fillable Required Document Instructions AFROTC Form 28: Provide to (University of Colorado at Boulder)

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Required Document Instructions AFROTC Form 28: Provide to (University of Colorado at Boulder)

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Required Document Instructions
AFROTC Form 28: Provide to a clinic,doctor or a physician to complete the highlighted section of the form
D
D Form 93: Complete and fill out the highlighted sections
DD Form 2005: Complete form, sign and date
Drug Testing Policy: Sign, date and notarize
Mail Access Authorization Letter: Sign, date and notarize
Transcript Release Form: Sign, date and notarize
DoDMERB Application Form: Sign and date
DD Form 2983: Complete blocks 1-7 and 9 (Make sure to initial all of block 7), sign and date
AFROTC Academic Degree Plan: See attachment 8 instructions
I CERTIFY THIS CADET/APPLICANT'S LEAN BODY MASS POSES NO HEALTH RISK; NO SIGNS OF EATING DISORDERS EXIST. I HAVE DISCUSSED THE
I
I HAVE DISCUSSED APPROPRIATE AND SAFE WEIGHT LOSS WITH THE CADET/APPLICANT.
FROM PARTICIPATING IN A RIGOROUS PHYSICAL TRAINING PROGRAM. IF A MEDICAL CONDITION/PHYSICAL IMPAIRMENT EXISTS THAT MAY
PRECLUDE THE INDIVIDUAL FROM PARTICIPATING, PLEASE EXPLAIN:
FIND MEDICAL CONDITION(S) OR PHYSICAL IMPAIRMENT(S) THAT WOULD PRECLUDE THIS CADET/APPLICANT
AIR FORCE ROTC PRE-PARTICIPATORY SPORTS PHYSICAL
AFROTC FORM 28, 20180423
PHYSICIAN OR MEDICAL AUTHORITY SIGNATUREEXAMINATION DATE
2. AFROTC DETACHMENT
8. MEDICAL AUTHORITY:
(Medical Authority Initials)
DID / DID NOT
(please circle)
(Medical Authority Initials)
9. (IF CADET/APPLICANT IS BELOW AIR FORCE WEIGHT STANDARDS)
(FOR ALL CADETS/APPLICANTS)
(IF CADET/APPLICANT EXCEEDS AIR FORCE WEIGHT STANDARDS)
PLEASE REVIEW THE ABOVE INFORMATION. CONDUCT COUNSELING BELOW IN APPLICABLE AREAS, AND SIGN.
I,
10.
11.
(print name)
, HAVE EXAMINED THIS CADET/APPLICANT AND REVIEWED
HIS/HER MEDICAL HISTORY. THE FOLLOWING ARE THE RESULTS:
1. CADET/APPLICANT NAME
MEDICAL AUTHORITY:
EXCEEDS AIR FORCE WEIGHT STANDARDS
IS BELOW AIR FORCE WEIGHT STANDARDS
IMPORTANCE OF NUTRITION AND WEIGHT MANAGEMENT.
IS WITHIN AIR FORCE WEIGHT STANDARDS
6. BODY FAT STANDARDS:
FEMALE - 26%
MALE - 18%
7. CHECK APPLICABLE BOX
MINIMUM MAXIMUM
3. CADET/APPLICANT MEASUREMENTS HEIGHT WEIGHT
4. AIR FORCE WEIGHT STANDARDS
(found on reverse)
Measure height and weight of cadet/applicant. Compare results to AF standards listed on reverse, check block 7 and
AFROTC CADRE:
If cadet/applicant exceeds AF weight standards, conduct a Body Fat Measurement IAW DoDI 1308.3.
REVIEW THE INFORMATION ENTERED ABOVE AND SIGN BELOW:
AFROTC CADRE:
AFROTC CADRE SIGNATUREDATE
5. BODY FAT MEASUREMENT
AFROTC Det 105
certify as requested below.
AFI 36-2905_AFROTCSUP
AFROTC FORM 28, 20180423 (BACK)
ACCESSION HEIGHT AND WEIGHT STANDARDS & BODY FAT MEASUREMENT (BFM) STANDARDS
MAXIMUM (BMI = 25.0 kg/m)
HEIGHT (INCHES)
58 119
124
128
132
136
141
145
150
205
210
155
159
164
169
174
179
184
189
194
200
216
221
227173
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
POUNDS
MINIMUM (BMI = 19 kg/m)
91
94
97
100
104
107
110
114
156
160
117
121
125
128
132
136
140
144
148
152
164
168
(Per DoDI 1308.3,
DoD Physical Fitness and Body Fat Programs Procedures)
AFI 36-2905_AFROTCSUP
RECORD OF EMERGENCY DATA
PRIVACY ACT STATEMENT
AUTHORITY:
PRINCIPAL PURPOSES:
For military personnel
For civilian personnel
ROUTINE USES:
DISCLOSURE:
INSTRUCTIONS TO SERVICE MEMBER
1. NAME (Last, First, Middle Initial) 2. SSN
3a. SERVICE/CIVILIAN CATEGORY
b. REPORTING UNIT CODE/DUTY STATION
4a. SPOUSE NAME (If applicable) (Last, First, Middle Initial)
b. SPOUSE ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER
5. CHILDREN
a. NAME (Last, First, Middle Initial)
b. RELATIONSHIP
c. DATE OF BIRTH
(YYYYMMDD)
d. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER
DD FORM 93, JAN 2008
This form is used
by the Department of Defense (DoD) to expedite notification in
the case of emergencies or death.
INSTRUCTIONS TO CIVILIANS
ARMY NAVY
MARINE CORPS AIR FORCE
CIVILIAN CONTRACTORDoD
SINGLE DIVORCED WIDOWED
IMPORTANT: This form is divided into two sections: Section 1 - Emergency Contact Information and Section 2 - Benefits Related
Information. READ THE INSTRUCTIONS ON PAGES 3 AND 4 BEFORE COMPLETING THIS FORM.
SECTION 1 - EMERGENCY CONTACT INFORMATION
6a. FATHER NAME (Last, First, Middle Initial) b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER
7a. MOTHER NAME (Last, First, Middle Initial) b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER
8a. DO NOT NOTIFY DUE TO ILL HEALTH b. NOTIFY INSTEAD
10. CONTRACTING AGENCY AND TELEPHONE NUMBER (Contractors only)
9a. DESIGNATED PERSON(S) (Military only)
b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER
AFROTC Det 105 / Boulder, CO
N/A
Address:
Phone Number:
Phone Number
Address:
ATTACHMENT 1
11a. BENEFICIARY(IES) FOR DEATH GRATUITY
(Military only)
c. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER d. PERCENTAGE
12a. BENEFICIARY(IES) FOR UNPAID PAY/ALLOWANCES
(Military only) NAME AND RELATIONSHIP
b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER c. PERCENTAGE
13a. PERSON AUTHORIZED TO DIRECT DISPOSITION (PADD)
(Military only) NAME AND RELATIONSHIP
14. CONTINUATION/REMARKS
15. SIGNATURE OF SERVICE MEMBER/CIVILIAN (Include rank, rate,
or grade if applicable)
16. SIGNATURE OF WITNESS (Include rank, rate, or grade
as appropriate)
17. DATE SIGNED
(YYYYMMDD)
b. ADDRESS (Include ZIP Code) AND TELEPHONE NUMBER
SECTION 2 - BENEFITS RELATED INFORMATION
DD FORM 93 (BACK), JAN 2008
b. RELATIONSHIP
N/A
N/A
N/A N/A
N/A
N/A
N/A
N/A
N/A
If you have Life Insurance please write down the company name and coverage. If no Life Insurance please write "None" and Initials
PRIVACY ACT STATEMENT - HEALTH CARE RECORDS
This form is not an authorization or consent to use or disclose your health information.
1. AUTHORITY FOR COLLECTION OF INFORMATION INCLUDING SOCIAL SECURITY NUMBER (SSN):
Information may be collected from you to provide and document your medical care; determine your eligibility for benefits
and entitlements; adjudicate claims; determine whether a third party is responsible for the cost of Military Health System
(MHS) provided healthcare and recover that cost; evaluate your fitness for duty and medical concerns which may have
resulted from an occupational or environmental hazard; evaluate the MHS and its programs; and perform administrative tasks
related to MHS operations and personnel readiness.
2. PRINCIPAL PURPOSES FOR WHICH INFORMATION IS INTENDED TO BE USED:
Voluntary. If you choose not to provide the requested information, comprehensive health care services may not be possible,
you may experience administrative delays, and you may be rejected for service or an assignment. However, care will not be
denied.
This all inclusive Privacy Act Statement will apply to all requests for personal information made by MHS health care treatment
personnel or for medical/dental treatment purposes and is intended to become a permanent part of your health care record.
Your signature merely acknowledges that you have been advised of the foregoing. If requested, a copy of this form will be
furnished to you.
4. WHETHER DISCLOSURE IS MANDATORY OR VOLUNTARY AND EFFECT ON INDIVIDUAL OF NOT PROVIDING
INFORMATION:
Information in your records may be disclosed to:
Private physicians and Federal agencies, including the Department of Veterans Affairs, Health and Human Services, and
Homeland Security (with regard to members of the Coast Guard), in connection with your medical care;
Government agencies to determine your eligibility for benefits and entitlements;
Government and nongovernment third parties to recover the cost of MHS provided care;
Public health authorities to document and review occupational and environmental exposure data; and
Government and nongovernment organizations to perform DoD-approved research.
Information in your records may be used for other lawful reasons which may include teaching, compiling statistical data, and
evaluating the care rendered. Use and disclosure of your records outside of DoD may also occur in accordance with 5 U.S.C.
552a(b) of the Privacy Act of 1974, as amended, which incorporates the DoD Blanket Routine Uses published at:
http://dpcld.defense.gov/privacy/SORNsIndex/BlanketRoutineUses.aspx.
Any protected health information (PHI) in your records may be used and disclosed generally as permitted by the HIPAA
Privacy Rule (45 CFR Parts 160 and 164), as implemented within DoD by DoD 6025.18-R. Permitted uses and disclosures of
PHI include, but are not limited to, treatment, payment, and healthcare operations.
3. ROUTINE USES:
10 U.S.C. 136, Under Secretary of Defense for Personnel and Readiness; 10 U.S.C. Chapter 55, Medical and Dental Care;
42 U.S.C. Chapter 32, Third Party Liability for Hospital and Medical Care; 32 CFR Part 199, Civilian Health and Medical
Program of the Uniformed Services (CHAMPUS); DoDI 6055.05, Occupational and Environmental Health (OEH); and
E.O. 9397 (SSN), as amended.
5. SIGNATURE OF PATIENT OR SPONSOR
6. SOCIAL SECURITY NUMBER OR
DOD IDENTIFICATION NUMBER
OF MEMBER OR SPONSOR
7. DATE (YYYYMMDD)
DD FORM 2005, JUN 2016
PREVIOUS EDITION IS OBSOLETE.
Adobe Designer 9.0
ATTACHMENT 2
________________________________________
Cadet Signature and Date
____________________________________________
Parent/Guardian Signature and Date
(Only for applicants under legal age of 18)
____________________________________
Printed Name and Signature of
Notary and
Date
ATTACHMENT 3
DEPARTMENT OF THE AIR FORCE
AIR UNIVERSITY (AETC)
MEMORANDUM OF UNDERSTANDING FOR DRUG TESTING POLICY
FOR CADETS PARTICIPATING IN RESERVE OFFICER TRAINING CORPS (ROTC)
By direction of the Secretary of the Air Force, I understand as an Air Force ROTC cadet
participating in a ROTC program, I will be subject to random urinalysis drug testing. I
understand that if I am randomly selected, I must provide the requested sample within the
specified time limits. I understand failure to report for a mandatory urinalysis test will be
considered an Unauthorized Absence (UA) and will result in individual command-directed
screening. I understand that any individual refusing to submit a urinalysis sample or testing
positive on a urinalysis test will be processed for disenrollment or dismissal from Air Force
ROTC or specific officer commissioning program.
DEPARTMENT OF THE AIR FORCE
AIR UNIVERSITY (AETC)
The Detachment Commander (CC), the Personnel NCO (DP), and the Information Management
NCO (IM) need to open official US Air Force (USAF) correspondence delivered to the
detachment addressed to cadets. Access to these documents is for the verification and accuracy
of the contents ONLY. Specific documents we open are: assignment orders for cadets entering
active duty, cadet travel summaries, and cadet Leave and Earnings Statements (LES). We must
verify these documents when received to ensure accuracy and to immediately correct or report
any discrepancies to higher headquarters. In accordance with the Privacy Act, we must have
your permission to access this mail. Therefore, request you sign your payroll signature below to
consent to our access. Giving consent is strictly voluntary. However, if you do not give your
consent, delays may be encountered in processing these vital items. Only OFFICIAL USAF
correspondence specifically approved by the detachment commander will be opened. Please
sign below if you agree to authorize cadre members to open OFFICIAL USAF mail addressed to
you.
________________________________________
Cadet Signature and Date
____________________________________________
Parent/Guardian Signature and Date
(Only for applicants under legal age 18)
____________________________________
Printed Name and Signature of Notary and Date
ATTACHMENT 4
AIR UNIVERSITY (AETC)
DATE:_________________
CADET NAME ___________________________________
1. In compliance with PL 93-389, “Family Educational Rights and Privacy Act”, your consent is
required to permit the educational institution or AFROTC Detachment in which you are/were enrolled
to release official copies of your transcripts of grades and/or other student records, files, or data that
are a part of your student records to Department of Defense (DOD) agencies, as may be required by
such agencies.
2. It is mutually understood that the purposes of this request for official copies of student records is
necessary for AFROTC screening and evaluation of tis present and potential cadet members and those
cadets commissioned or disenrolled from the AFROTC program. It is further understood that the
privacy of the information collected by means of this request will be maintained in accordance with the
Privacy Act of 1974 and the Freedom of Information Act, and the information will be used for official
AFROTC evaluation.
3. Your signature below signifies receipt and agreement of the above statement and that you have
read and understand our request for official copies of your school records. And you hereby voluntarily
consent to the release of such official records as we may require in the above stated request. You
therefore authorize appropriate school officials or detachment personnel to release to the above
requestor, their successor, or to the appropriate DOD agency any and all official records, files, and data
for their use as requested above.
_________________________________ ___________________________________
(Student’s Signature) (Parent’s Signature if student is under 18 years
of age)
ATTACHMENT 5
DEPARTMENT OF THE AIR FORCE
DoDMERB Application Form
First Name:_______________________________________________________________
Last Name:_______________________________________________________________
Middle Initial:_____________________________________________________________
Full Social Security Number:__________________________________________________
Birth Date (MM/DD/YYYY):___________________________________________________
Gender: Male
Female
Ap
plicant Email:____________________________________________________________
Cellphone:_________________________________________________________________
Street Address:_____________________________________________________________
City: ______________________________________________________________________
State: _____________________________________________________________________
Zip Code:___________________________________________________________________
Have you completed a DoDMERB medical exam from a previous ROTC Application, Service Academy
Application or Military Entry? Yes No
If
yes, provide the date of exam (MM/DD/YYYY): _____________________
ATTACHMENT 6
RECRUIT/TRAINEE PROHIBITED ACTIVITIES ACKNOWLEDGMENT
INSTRUCTIONS
In accordance with DoDI 1304.33, this form will be read and signed no later than the first visit with a recruiter following a recruit's entry
into the Delayed Entry Program or read and signed no later than the first day of entry-level training for a trainee. As a minimum, the
signed original will be retained in the recruit's file until they enter active duty or in the trainee's file until they detach from the training
command or school they are attending. Please initial beside each entry acknowledging that you have read and understand the
statement.
1. RECRUIT/TRAINEE NAME (Last, First, Middle)
4. RECRUITING OFFICE/TRAINING COMMAND
ADDRESS (City, State, ZIP Code)
5. DATE SIGNED
(YYYYMMDD)
2. PAY GRADE 3. RECRUITING OFFICE/TRAINING COMMAND
6. SIGNATURE
7. I ACKNOWLEDGE AND UNDERSTAND THAT AS A RECRUIT OR TRAINEE, I WILL NOT:
10. APPROVED BY
(Initial)
a. Develop, attempt to develop, or conduct a personal, intimate, or sexual relationship with a recruiter or trainer.
This includes, but is not limited to, dating, handholding, kissing, embracing, caressing, and engaging in sexual
activities. Prohibited personal, intimate, or sexual relationships include those relationships conducted in person or
via cards, letters, e-mails, telephone calls, instant messaging, video, photographs, social networking, or any other
means of communication.
b. Establish a common household with a recruiter/trainer, that is, share the same living area in an apartment, house,
or other dwelling.
f. Gamble with a recruiter/trainer.
h. Lend money to, borrow money from, or otherwise become indebted to a recruiter/trainer.
g. Make sexual advances toward, or seek or accept sexual advances or favors from, a recruiter/trainer.
e. Allow entry of any recruiter/trainer in my dwelling or privately-owned vehicle except to conduct official business.
Exceptions are permitted for official business when the safety or welfare of the recruiter/trainer is at risk.
d. Attend social gatherings, clubs, bars, theaters or similar establishments on a personal social basis with a recruiter/
trainer.
c. Consume alcohol with a recruiter/trainer on a personal social basis.
8. EXCEPTIONS. Exceptions may be granted to accommodate relationships that existed prior to the start of the recruiting process or
prior to the trainee starting the formal training process. These relationships include, but are not limited to, family members. Only
the Recruit's or Trainee's Commander, O-4 or higher, or higher level authority, has the authority to approve these exceptions.
Approved exceptions will be documented below and signed by the Recruit's or Trainee's Commander, O-4 or higher, or a higher-
level authority.
DESCRIPTION OF EXCEPTION(S):
a. NAME (Last, First, Middle Initial) d. SIGNATURE/RANKb. TITLE
c. DATE SIGNED
(YYYYMMDD)
DD FORM 2983, JAN 2015
Adobe Designer 9.0
9. VIOLATIONS. Violations of any part of paragraph 7.a. through 7.h., not granted an exception in paragraph 8, may
result in disciplinary action.
(Initial)
AUTHORITY: 10 U.S.C. 136, Under Secretary of Defense for Personnel and Readiness; DoD Instruction 1304.33, Standardized
Protection Policies Prohibiting Inappropriate Relations Between Recruiters and Recruits, and Trainers and Trainees.
PRINCIPAL PURPOSE(S): To document your understanding of the prohibitions identified in section 7 of this form.
ROUTINE USE(S): The DoD Blanket Routine Uses found at http://dpclo.defense.gov/Privacy/SORNsIndex/BlanketRoutineUses.aspx
apply to this collection.
DISCLOSURE: Voluntary. However, if you fail to provide the requested information or complete this form, you might not be able to
complete your enlistment or receive training.
PRIVACY ACT STATEMENT
AFROTC Detachment 105 / AETC
Boulder, CO, 80309
ATTACHMENT 7
Applicant
Attachment 8
Det 105 Academic Plan Instructions
1. YOU MUST FILL THIS OUT ALL THE WAY UNTIL GRADUATION!
- This includes every semester from your first semester in college (which also includes all six
semester in between) and your final semester in college.
- This is an academic plan, not an academic what is my name and date plan
- This document will change so if you are wrong about Spring 2023 classes that is fine.
2. EXAMPLES:
- Freshmen:
o Section II, Eight blocks filled in with classes: fall 2020 followed by spring 2021,
followed by fall 2021, followed by spring 2022 and so on until graduation date.
- Sophomores:
o Section II: Fill in completed courses that are valid for THE CURRENT MAJOR you are
in progress of completing then starting in fall 2020 project until graduation.
3. WEBSITE LINKS
- Each University has their own website link guides in order for you to copy directly from your
course catalog directly onto the Academic Plan so there was no confusion.
4. ADOBE:
- It works best if you can find a computer with adobe reader dc installed (which is free just
google adobe reader dc and download) then you don’t have to print it out to fill it out but if
you print it and fill it out
5. ACADEMIC PLAN INSTRUCTIONS:
A. Save the Det 105 Academic Plan to your computer (found three pages from this one)
B. Section I:
1. Fill in items 1, 2, 3, & Date of Graduation & Date of Commissioning
2. Academic Advisor review IS NOT required at this time, we only need a in place according
to HQ direction.
3. This plan WILL CHANGE so do not worry about it being perfect, I will work with you
again during mid-term counseling in the spring.
B. Section II
1. 1
st
Block: Enter the first term in college after YEAR for previous college courses
2. 2
nd
Block: Enter any other college after YEAR for previous college courses
3. 3
rd
Block through 100
th
Block: Enter the courses that will be taken during each semester
until graduation for four year schools
i. If you are guessing at this time, that is fine, this document WILL CHANGE!
ii. Two years schools, just project up until transfer, then pull the catalog from the
University you plan on transferring to in order to complete the form
4. Use the catalog from the university you are attending to guide your plan found below:
iii. Arapahoe Community College: https://www.arapahoe.edu/pathways
1. Select your major
2. Find course requirements
3. Enter the courses into the Form 48 until projected transfer
iv. Colorado Christian University:
https://catalog.ccu.edu/content.php?catoid=30&navoid=1883
1. Select your major
Attachment 8
Det 105 Academic Plan Instructions
2. Enter courses listed under General Education Requirements and Biology
Major Core each semester you plan on taking onto the form 48 until
graduation
v. Colorado Technical University: https://www.coloradotech.edu/degrees
1. Select View Major under your major
2. Enter the courses under Degree Requirements each semester you plan
on taking onto the form 48 until graduation
vi. DeVry University: https://www.devry.edu/online-programs.html
1. Select your program
2. Select your area of study
3. Select your specialization
4. Enter the courses found at the bottom of the page each semester you
plan on taking onto the form 48 until graduation
vii. Front Range Community College:
https://frontrange.smartcatalogiq.com/en/Current/Catalog/Programs-A-Z
1. Select your program
2. Find My Academic Plan
3. Enter the courses found under first/second/third/fourth semester until
transfer
viii. Metropolitan State
University:
https://catalog.msudenver.edu/content.php?catoid=35&navoid=23
40
1. Find Undergraduate Majors
2. Select your major
3. Enter courses found listed you plan on taking onto the Form 48 until
graduation
ix. Regis University: https://www.regis.edu/academics/majors-and-programs/index
1. Contact me for instructions, the site is not easy to navigate course
requirements
x. University of Colorado-Boulder: https://catalog.colorado.edu/undergraduate/
1. Select + on College, Schools & Programs
2. Select + on the College that contains your major
3. Select + on Programs of Study
4. Select your major
5. Select the Plan(s) of Study tab
6. If listed by semester, enter that directly into the form 48; if listed
otherwise create a plan based on the courses listed
xi. University of Colorado-Colorado Springs:
http://catalog.uccs.edu/content.php?catoid=16&navoid=1219
1. Select your major
2. If listed by semester, enter that directly into the form 48; if listed
otherwise create a plan based on the courses listed
xii. University of Colorado-Denver:
http://catalog.ucdenver.edu/content.php?catoid=28&navoid=8259
1. Contact me for instructions, the site is not easy to navigate course
requirements
Attachment 8
Det 105 Academic Plan Instructions
xiii. University of Denver:
http://bulletin.du.edu/undergraduate/majorsminorscoursedescriptions/traditio
nalbachelorsprogrammajorandminors/
1. Select your major
2. Select the Course Plan tab
3. Enter the courses as listed into the Form 48 as listed.
5. Add our courses found here: https://catalog.colorado.edu/courses-a-z/airr/
xiv. AIRR1010 is fall semester, AIRR1020 is spring of first year, AIRR2010 is fall
semester, AIRR 2020 is spring semester of second year and so on…
6. Upload the Detachment 105 Academic Plan into WINGS
Detachment 105 Academic Plan
ACADEMIC PLAN/TERM REVIEW
1. NAME
(Last, First, MI)
2. ACADEMIC INSTITUTION/AFROTC DETACHMENT 3. ACADEMIC MAJOR
6. I CERTIFY THIS STUDENT HAS SUCCESSFULLY COMPLETED ALL DEGREE
REQUIREMENTS AND WILL GRADUATE THIS TERM
ACADEMIC ADVISOR
OFFICIALS SIGNATURE/DATE
CADET SIGNATURE/DATE
TERM: YEAR: TERM: YEAR:
Course
Number
Course
Number
Credit
Hours
COURSE TITLE
TOTAL CREDIT HOURS ATTEMPTED
TOTAL CREDIT HOURS ATTEMPTED
REMARKS/DEVIATIONS
AFROTC REVIEWER'S SIGNATURE/DATE
DO NOT SIGN BLOCK 6--UNITL AFTER FINAL EXAMS
4.
INSTITUTIONAL OFFICIAL REVIEW and validation that degree is accreditted
ACADEMIC ADVISOR
OFFICIALS SIGNATURE/DATE
5. INITIAL REVIEW
PROJECTED DATE OF GRADUATION: MTH-YR
PROJECTED DATE DATE OF COMMISSIONING: MTH-YR
Credit
Hours
COURS
E TITLE
Previous Coursework
Previous Coursework
SECTION I.
SECTION II.
REMARKS/DEVIATIONS
University of Colorado-Boulder / Det 105
0
0
Detachment 105 Academic Plan
1. NAME
(Last, First, MI)
TERM: YEAR: TERM: YEAR:
Course
Number
Course
Number
Credit
Hours
COURSE TITLE
TOTAL CREDIT HOURS ATTEMPTED TOTAL CREDIT HOURS ATTEMPTED
REMARKS / DEVIATIONS
Credit
Hours
COURSE TITLE
TERM: YEAR: TERM: YEAR:
Course
Number
Course
Number
Credit
Hours
COURSE TITLE
TOTAL CREDIT HOURS ATTEMPTED
REMARKS / DEVIATIONS
Term
COURSE TITLE
REMARKS / DEVIATIONS
REMARKS / DEVIATIONS
Fall
2021
Spring
2022
AIRR1010
Heritage & Values I
1
AIRR1020
Heritage & Values II
1
1
1
Summer
2022
AFROTC Events
AY2021-22
AIRR1234
LLAB
Fall
AIRR1234
LLAB
Spring
0
0
Detachment 105 Academic Plan
1. NAME
(Last, First, MI)
TERM: YEAR: TERM: YEAR:
Course
Number
Course
Number
Credit
Hours
COURSE TITLE
TOTAL CREDIT HOURS ATTEMPTED
TOTAL CREDIT HOURS ATTEMPTED
REMARKS / DEVIATIONS
Credit
Hours
COURSE TITLE
TERM: YEAR: TERM: YEAR:
Course
Number
Course
Number
Credit
Hours
COURSE TITLE
TOTAL CREDIT HOURS ATTEMPTED
REMARKS / DEVIATIONS
Term
COURSE TITLE
REMARKS / DEVIATIONS
REMARKS / DEViATIONS
CADET SIGNATURE/DATE
AFROTC REVIEWER'S SIGNATURE/
DATE
Academic Advisor
SIGNATURE/DATE
CADET SIGNATURE/DATE
AFROTC REVIEWER'S SIGNATURE/
DATE
Academic Advisor
SIGNATURE/DATE
Fall
2022
Spring
2023
AIRR2010
Team & Leadership Fundamentals I
1
AIRR2020
Team & Leadership Fundamentals II
1
1
1
Summer
2023
AFROTC Events
AY2022-23
AIRR1234
LLAB
Fall
AIRR1234
LLAB
Spring
Other
Field Training
Summer
0
0
Detachment 105 Academic Plan
1. NAME
(Last, First, MI)
TERM: YEAR: TERM: YEAR:
Course
Number
Course
Number
Credit
Hours
COURSE TITLE
TOTAL CREDIT HOURS ATTEMPTED TOTAL CREDIT HOURS ATTEMPTED
REMARKS / DEVIATIONS
Credit
Hours
COURSE TITLE
TERM: YEAR: TERM: YEAR:
Course
Number
Course
Number
Credit
Hours
COURSE TITLE
TOTAL CREDIT HOURS ATTEMPTED
REMARKS / DEVIATIONS
Term
COURSE TITLE
REMARKS / DEVIATIONS
REMARKS / DEVIATIONS
CADET SIGNATURE/DATE
AFROTC REVIEWER'S SIGNATURE/
DATE
Academic Advisor
SIGNATURE/DATE
CADET SIGNATURE/DATE
AFROTC REVIEWER'S SIGNATURE/
DATE
Academic Advisor
SIGNATURE/DATE
Fall
2023
Spring
2024
AIRR3010
Leading People & Effective Communication I
3
AIRR3020
Leading People & Effective Communication II
3
3
3
Summer
2024
AFROTC Events
AY2023-24
AIRR1234
LLAB
AIRR1234
LLAB
0
0
Detachment 105 Academic Plan
1. NAME
(Last, First, MI)
TERM: YEAR: TERM: YEAR:
Course
Number
Course
Number
Credit
Hours
COURSE TITLE
TOTAL CREDIT HOURS ATTEMPTED TOTAL CREDIT HOURS ATTEMPTED
REMARKS / DEVIATIONS
Credit
Hours
COURSE TITLE
TERM: YEAR: TERM: YEAR:
Course
Number
Course
Number
Credit
Hours
COURSE TITLE
TOTAL CREDIT HOURS ATTEMPTED TOTAL CREDIT HOURS ATTEMPTED
REMARKS / DEVIATIONS
Credit
Hours
COURSE TITLE
REMARKS DEVIATIONS
REMARKS / DEVIATIONS
CADET SIGNATURE/DATE
AFROTC REVIEWER'S SIGNATURE/
DATE
Academic Advisor
SIGNATURE/DATE
CADET SIGNATURE/DATE
AFROTC REVIEWER'S SIGNATURE/
DATE
Academic Advisor
SIGNATURE/DATE
Fall
2024
Spring
2025
AIRR4010
National Security & Leadership/Comm Prep I
3
AIRR40120
National Security & Leadership/Comm Prep II
3
3
3
Summer
2025
AFROTC Events
AY2024-25
0
0
Detachment 105 Academic Plan
1. NAME
(Last, First, MI)
TERM: YEAR: TERM: YEAR:
Course
Number
Course
Number
Credit
Hours
COURSE TITLE
TOTAL CREDIT HOURS ATTEMPTED TOTAL CREDIT HOURS ATTEMPTED
REMARKS / DEVIATIONS
Credit
Hours
COURSE TITLE
TERM: YEAR: TERM: YEAR:
Course
Number
Course
Number
Credit
Hours
COURSE TITLE
TOTAL CREDIT HOURS ATTEMPTED
REMARKS / DEVIATIONS
Term
COURSE TITLE
REMARKS / DEVIATIONS
REMARKS / DEVIATIONS
CADET SIGNATURE/DATE
AFROTC REVIEWER'S SIGNATURE/
DATE
Academic Advisor
SIGNATURE/DATE
CADET SIGNATURE/DATE
AFROTC REVIEWER'S SIGNATURE/
DATE
Academic Advisor
SIGNATURE/DATE
Fall
20XX
Spring
20XX
0
0
Summer
20XX
AFROTC Events
AY20XX-2X
0
0
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Completed 19 May 2022

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