Surveypoint

Q1

Full Name

First Name

Q2

Full Name

Middle Name

Q3

Full Name

Last Name

Q4

Full Name

Suffix

Q5

Phone Number

Q6

Best times to contact you?

Q7

Email

Q8

Address

Street Address

Q9

Address

Street Address Line 2

Q10

Address

City

Q11

Address

Zip Code

Q12

Address

State

Q13

What is your Social Media platform and handle?

Q14

Are you a US Citizen?

Q15

College/University

Q16

Graduation/Expected Graduation

Q17

Minor/Major

Q18

Number of Credits Enrolled in

Q19

Last Semester GPA/ Cumulative GPA

Q20

Test Scores - SAT, ACT, LSAT, or ASVAB

Q21

List any other Colleges you've Attended and Degrees Awarded

Q22

Are you or were you involved in any sports, activities, organizations, clubs, etc. while in high school or college?

Q23

Date of Birth mm/dd/yyyy

Q24

Age

Q25

RACE

Q26

Ethnicity

Q27

Birth Sex/Preferred Gender

Q28

Height

Q29

Weight

Q30

Vision (select all that apply)

Q31

Are you color blind?

Q32

Have you ever had asthma or used an inhaler?

Q33

Have you ever been diagnosed with ADD, ADHD, or any learning disorder?

Q34

Are you currently prescribed any medications or do you have any history of medications for any reason (sleep, acne, depression, ADD/ADHD, etc)

Q35

Do you have any prolonged medical conditions or diseases?

Q36

Have you ever had any broken bones, cracked bones, fractures, sprains/strains, tears, dislocations, or any other injury that required a trip to an emergency room?

Q37

Do you have any Implants? (plates, rods, pins, screws, etc)

Q38

Have you ever had any types of surgeries or procedures? (stitches/staples, wisdom teeth, appendectomy, tonsilectomy, tubes in ears, or any more serious procedures)

Q39

Have you ever attended counseling or saw a Psychiatrist for any reason? (even if it was voluntary)

Q40

Do you exercise regularly? How often? What does your workout consist of?

Q41

Do you have any tattoos/brandings/piercings? If yes, explain what they are, location, and size.

Q42

Have you ever received any type of traffic tickets, parking tickets, speeding tickets, etc.?

Q43

Have you ever been arrested, put on probation, or detained for any reason? (explain all, even if you were told the records were sealed or expunged)

Q44

Are you currently pending any legal action?

Q45

Have you ever used any illegal drugs, even one time? If yes, explain what it was, how many times and the last usage.

Q46

Marital Status

Q47

Do you have any children? (If yes, how many?)

Q48

Do you have any family members that served in the Armed Forces? (if yes, explain which branch, and whether active, retired, or reserve)

Q49

Have you ever served in the Armed Forces? (if yes, which branch, rank, discharge date?)

Q50

Have you ever attempted to join the Armed Forces?

Q51

Are you a member of a military Reserve Unit? (if yes, name your unit, its location)

Q52

How did you hear about the Marine Corps Officer Programs? If by referral, who referred you?

Q53

Why do you want to be a Marine Officer? What is it about you, that makes you a good candidate for this program?

Q54

Select the Marine Officer Program options that interest you the most? (check all that apply)

Q55

Contact Screening -Form Fill

Full Name

Full Name

Full Name

Full Name

Phone Number

Best times to contact you?

Email

Address

Address

Address

Address

Address

What is your Social Media platform and handle?

Are you a US Citizen?

College/University

Graduation/Expected Graduation

Minor/Major

Number of Credits Enrolled in

Last Semester GPA/ Cumulative GPA

Test Scores - SAT, ACT, LSAT, or ASVAB

List any other Colleges you've Attended and Degrees Awarded

Are you or were you involved in any sports, activities, organizations, clubs, etc. while in high school or college?

Date of Birth mm/dd/yyyy

Age

RACE

Ethnicity

Birth Sex/Preferred Gender

Height

Weight

Vision (select all that apply)

Are you color blind?

Have you ever had asthma or used an inhaler?

Have you ever been diagnosed with ADD, ADHD, or any learning disorder?

Are you currently prescribed any medications or do you have any history of medications for any reason (sleep, acne, depression, ADD/ADHD, etc)

Do you have any prolonged medical conditions or diseases?

Have you ever had any broken bones, cracked bones, fractures, sprains/strains, tears, dislocations, or any other injury that required a trip to an emergency room?

Do you have any Implants? (plates, rods, pins, screws, etc)

Have you ever had any types of surgeries or procedures? (stitches/staples, wisdom teeth, appendectomy, tonsilectomy, tubes in ears, or any more serious procedures)

Have you ever attended counseling or saw a Psychiatrist for any reason? (even if it was voluntary)

Do you exercise regularly? How often? What does your workout consist of?

Do you have any tattoos/brandings/piercings? If yes, explain what they are, location, and size.

Have you ever received any type of traffic tickets, parking tickets, speeding tickets, etc.?

Have you ever been arrested, put on probation, or detained for any reason? (explain all, even if you were told the records were sealed or expunged)

Are you currently pending any legal action?

Have you ever used any illegal drugs, even one time? If yes, explain what it was, how many times and the last usage.

Marital Status

Do you have any children? (If yes, how many?)

Do you have any family members that served in the Armed Forces? (if yes, explain which branch, and whether active, retired, or reserve)

Have you ever served in the Armed Forces? (if yes, which branch, rank, discharge date?)

Have you ever attempted to join the Armed Forces?

Are you a member of a military Reserve Unit? (if yes, name your unit, its location)

How did you hear about the Marine Corps Officer Programs? If by referral, who referred you?

Why do you want to be a Marine Officer? What is it about you, that makes you a good candidate for this program?

Select the Marine Officer Program options that interest you the most? (check all that apply)

Out of the 15 benefits listed below. Select FIVE that stand out to you.