Military Prep Program Application | Youth Military Coalition

YMC Military Prep Program Application

Recruit Last name

Recruit First name

Recruit Email

Recruit Phone

Recruit Emergency Contact

Recruit Date Of Birth

Month

Day

Year

Today's Date

Month

Day

Year

How did you hear about us?

Friends

Social Media

Other

What branch of service are you interested in?

General Questions

Why Choose That Particular Military Branch?

Why do you want to serve in the military?

Has anyone in your family served in the military, or is anyone currently serving?

Are you willing to receive firm, direct instruction and correction similar to military boot camp, at a reduced intensity, while being treated safely and respectfully?

Medical History & Health Information

Have you ever been diagnosed with cancer, including breast cancer, or a sexually transmitted infection such as chlamydia, gonorrhea, syphilis, genital herpes, HPV, HIV, or trichomoniasis? If yes, please explain.

Do you have any physical or mental health conditions we should know about to support your safe participation in the program?

Are you currently taking any medications? If yes, please list them and explain what they are prescribe or taken for.

Are you currently sick or experiencing symptom such as fever, cough, sore throat, vomiting, diarrhea, or flu-like symptom? If yes, please explain.

Is there any additional information you would like to share with us?

Applicant Certification, Assumption, Of Risk And Release.

Parent/Legal Guardian Signature (required if applicant is under 18):

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YMC Military Prep Program Application

General Questions

Medical History & Health Information

Applicant Certification, Assumption, Of Risk And Release.

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