Cadet Personal Data Entry

Information will be entered into Wheeling NJROTC’s NJUMS (cadet data base) and is used for NJROTC purposes only.

Student Information

Last Name:___________________________Legal First Name:______________________ MI:___

Nickname (if desired)_                   _______ ___ _______

STUDENT ID: ____________  SSN:____- _____- _______          DOB: __/___/____  Gender: M/F                                                              mm/dd/yyyy

Race:___________   US resident: Y/N   Home School:   BG  EG JH  PH  RM  WH  (Other)_______________

Street:______________________________________  Apartment: ____________

City: _____________________________ State:____  Zip: ________

Risk Screening Questionnaire completed: __/__/___ Pre-Sports-Physical:__/__/____

                                                  mm/dd/yyyy                   mm/dd/yyyy

Student Home Phone:(____ ) _____-__________      Student Work Phone(if apples): (____) ____-______

Student cell phone/pager information (if applies): _____________________________

E-mail address (if applies) _____________________________

School Year: 9, 10, 11, 12         Enrolled: __/__/___       Naval Science Class: 1,2,3,4

                                                   mm/dd/yyyy

Expected Graduation Date:  __/__/___                   

                                  mm/dd/yyyy      Cadet assignment in unit (for Unit use only)

                                                Battalion:        Company:

                                                Platoon:          Squad:

Parent/Guardian Information

A. Name: ________________________Relationship: ______________  Legal guardian: Y/N

    Street: ________________________________________  Apartment: __________

    City: __________________________________         State:_____  Zip:_______

    Home Phone:  (____ ) _____-________                           Work Phone:  (____ )  ____-________

     Cell Phone/pager information: __________________________________________________

    Best Way to reach during school day is ______________________ btwn _____________.

           E-mail address: ________________________________________________________________.

    Student resides with this guardian (student's legal residence): Yes/No

B.  Name: ________________________Relationship: ______________  Legal guardian: Y/N

    Street:__________________________________________ Apartment:____________

    City:_______________________________________     State:____ Zip:_________

        Home Phone:  (____ ) _____-________                           Work Phone:  (____ )  ____-________

     Cell Phone/pager information: __________________________________________________

    Best Way to reach during school day is ______________________ btwn _____________.

           E-mail address: ________________________________________________________________.

    Student resides with this guardian (student's legal residence): Yes/No