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All pages to his/her Marine Corps recruiter and complete these pages with the recruiter. MCRC REGULAR OFFICER (ON/E) APPLICATION AND PROGRAM INFORMATION SHEET LAST NAME, FIRST, MI FULL SSN RANK/PMOS EAS(YYMMDD) DOB(YYMMDD) RELIGION SEX MALE FEMALE HOME OF RECORD ADDRESS: 1234 Main Street EMAIL (INCLUDE COUNTY) Anywhere, US 22134 PHONE Your County Here UNIT ADDRESS PROGRAM NROTC NAVY MARITAL STATUS RACE CITIZENSHIP DTE OF PRGM ENTRY (board/msg date) CIVILIAN NAVAL ACADEMY NROTC MARINE.

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