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Military Template -Form Fill

Section One
Q1

Name

First Name
Q2

Name

Middle Name
Q3

Name

Last Name
Q4

Birth Date

Month
Q5

Birth Date

Day
Q6

Birth Date

Year
Q7

Gender
Q8

Address

Street Address
Q9

Address

Street Address Line 2
Q10

Address
Q11

Address
Q12

Address

Postal / Zip Code
Q13

Student E-mail
Q14

Mobile Number
Q15

High School
Q16

Select your level of education.
Q17

Height
Q18

Weight
Q19

Where were you born?

Q20

Citizenship Status:
Q21

Do any of the following items pertain to you? (Select all that apply)
Q22

What career fields interest you?
Q23

Select the employment benefits that interest you (select all that apply)
Q24

Would you consider receiving more information regarding the Marines Corps?
Q25

What questions do you have regarding the Marines Corps or the Armed Forces?