DEPARTMENT OF THE NAVY
MARINE CORPS REPRESENTATIVE
U.S. NAVAL ACADEMY
107 MARYLAND AVENUE
ANNAPOLIS, MD 21402·5044
18 Jan 16
From:
To:
Via:
MIDN Joseph David Marine, 555 55 5555/8001
Commanding General, Marine Corps Recruiting Command
Senior Marine United States Naval Academy
Subj:
REQUEST FOR APPOINTMENT TO COMMISSION AS A SECOND LIEUTENANT IN THE
UNITED STATES MARINE CORPS
Encl:
(1) Request for Appointment documents
1. I hereby submit my application for appointment to commission as a Second
Lieutenant in the U.S. Marine Corps (Active) upon completion of all academic
requirements for my degree no later than 27 May 2016. I will have written
verification of this degree on 27 May 2016 and desire to be commissioned on
27 May 2016.
2. My commissioning will be coordinated by Marine Liaison, LtCol Peter
Reitmeyer, Office of the Senior Marine Corps Representative, 107 Maryland
Ave. Annapolis, MD 21402.
3. My Home of Record is as stated on my current Academy contract. I have
provided each of my prior service contracts and separation documents from all
services and academies to reflect pay and service time. __ Army __ Navy __
Air Force__ National Guard _X_ Service Academy __ Reserve Officers Training
Corps. (Check all that apply)
4. I completed OCS (N/A) and expect to commission as: _X__ Ground
_ __ Student Naval Aviator ___ Student Naval Flight Officer.
5. Upon reporting to TBS, my marital status will be: ___ married _X_single.
I will provide supporting documents under separate cover.
6. I desire my commission to report the following: religious preference
____26____, race ____E____ and cultural ethnicity _____P_____.
(Reference RFA Guide for appropriate race/ethnicity information)
7. I desire to be assigned to The Basic School (TBS) class # __5-16___ which
convenes _28 Jun 2016___.
__________________
Signature
___________________
Witnessing Officer
DEPARTMENT OF THE NAVY
MARINE CORPS REPRESENTATIVE
U.S. NAVAL ACADEMY
107 MARYLAND AVENUE
ANNAPOLIS, MD 21402·5044
Race
A AMERICAN INDIAN OR ALASKA NATIVE
B ASIAN
C BLACK OR AFRICAN AMERICAN
D NATIVE HAWAIIAN OR OTHER PACIFIC
ISLAND
E WHITE
F DECLINED TO RESPOND
H AMERICAN INDIAN/ALASKA NATIVE,
ASIAN
J AMIN/ALNAT, ASIAN, BLACK
K AMIN/ALNAT, ASIAN, BLACK,
NATHAW/PACISL
L AMIN/ALNAT, AS, BL,
NATHAW/PACISL, WHITE
M AMIN/ALNAT, ASIAN, BLACK, WHITE
N AMIN/ALNAT, ASIAN, NATHAW/OTH PAC
ISL
P AMIN/ALNAT, ASIAN, NATHAW/PACISL,
WHITE
Q AMIN/ALASKA NATIVE, ASIAN, WHITE
R AMIN/ALNAT, BLACK OR AFRICAN
AMERICAN
S AMIN/ALNAT, BLACK, NATHAW/PACISL
T AMIN/ALNAT, BLACK, NATHAW/PACISL,
WHITE
U AMIN/ALNAT, BLACK, WHITE
V AMIN/ALNAT, NATHAW/PACISL
W AMIN/ALNAT, NATHAW/PACISL, WHITE
X AMERICAN INDIAN/ALASKA NATIVE,
WHITE
Y ASIAN, BLACK OR AFRICAN AMERICAN
Z ASIAN, BLACK, NATHAW/PACISL
32
34
36
38
40
41
44
45
46
47
48
49
50
53
55
56
57
58
60
62
64
66
68
70
72
74
75
99
A0
Religion
00 NO PREFERENCE
01 NO RELIGIOUS
02 SEVENTH-DAY
04 ASSEMBLIES OF GOD
05 GRACE GOSPEL
06 AMERICAN BAPTIST
07 INDEPENDENT BAPTIST
08 SOUTHERN BAPTIST
09 NATIONAL ASSC OF
10 BAPTIST - CHURCHES
12 BRETHREN CHURCH
13 CHRISTIAN - NO
14 BUDDHISM
16 CHRISTIAN
18 CHURCH OF CHRIST
19 CHURCH OF GOD IN
20 CHURCH OF GOD
24 CHRISTIAN CHURCH
26 PROTESTANT
AE
AA
AB
AC
AD
AF
AG
AH
AJ
AK
AL
AM
AN
AV
B0
BA
BB
BC
BD
BE
FRIENDS
JEHOVAH'S WITNESSES
JEWISH
CHURCH OF LATTER
LUTHERAN CHURCHES
LU THERAN COUNCIL
METHODIST
EVANGELICAL
EVANGELICAL
EVANGELICAL
MUSLIM
HINDU
CHURCH OF THE
EASTERN ORTHODOX
FULL GOSPEL
PENTECOSTAL
UNITED PENTECOSTAL
PRESBYTERIAN
REFORMED CHURCHES
ROMAN CATHOLIC
SALVATION ARMY
UNITARIAN
UNITED CHURCH OF
PROTESTANT - OTHER
PROTESTANT - NO
OTHER RELIGIONS
ATHEIST
UNKNOWN
AMERICAN COUNCIL OF CHRISTIAN
CHURCHES
ASBURY BIBLE CHURCHES
BIBLE PROTESTANT CHURCH
CONGREGATIONAL METHODIST CHURCH
EVANGELICAL METHODIST CHURCH OF
AMERICA
FUNDAMENTAL METHODIST CHURCH,
INC.
INDEPENDENT CHURCHES AFFILIATED
INDEPENDENT FUNDAMENTAL BIBLE
CHURCHES
TIOGA RIVER CHRISTIAN CONFERENCE
UKRANIAN EVANGELICAL BAPTIST
CONFERENCE
METHODIST PROTESTANT CHURCH
MILITANT FUNDAMENTAL BIBLE
CHURCHES
UNITED CHRISTIAN CHURCH
NATIVE AMERICAN
ADVENTIST CHURCHES
ASSOCIATED GOSPEL CHURCHES, THE
ANGLICAN ORTHODOX CHURCH, THE
BAPTIST BIBLE FELLOWSHIP
BRETHREN IN CHRIST FELLOWSHIP
CHRISTIAN CRUSADE
INDEPENDENT BAPTIST CHURCHES
RFA GUIDE (RACE/RELIGION/ETHNICITY)
BF
BG
BH
CA
CC
CD
CE
CG
CH
CI
CJ
D0
DA
DB
DC
DD
DE
DF
DG
DH
DJ
DL
DN
DP
DQ
DR
DS
DT
DU
DV
DW
DX
DY
DZ
E0
EA
ED
EE
INDEPENDENT LUTHERAN CHURCHES
SOUTHWIDE BAPTIST FELLOWSHIP
BIBLE PRESBYTERIAN CHURCH
AMERICAN BAPTIST ASSOCIATION
CATHOLIC CHURCHES
BAPTIST MISSIONARY ASSC OF
AMERICA
FREE WILL BAPTISTS
GENERAL ASSC OF REGULAR BAPTIST
CHURCHES
AMERICAN BAPTIST CONVENTION
AMERICAN BAPTIST CHURCHES IN THE
USA
WORLD BAPTIST FELLOWSHIP
GENERAL COMM ON CHAPLINS & AF
PERSONNEL
ADVENT CHRISTIAN CHURCH
AFRICAN METHODIST EPISCOPAL
CHURCH
AFRICAN METHODIST EPISCOPAL ZION
CHURCH
BAPTIST GENERAL CONFERENCE
CHRISTIAN METHODIST EPISCOPAL
CHURCH
CHRISTIAN REFORMED CHURCH
CHURCH OF GOD (ANDERSON, IN)
CHURCH OF GOD IN NORTH AMERICA
EVANGELICAL CONGREGATIONAL
CHURCH
FREE WILL BAPTISTS, NC STATE
CONVENTION DM MORAVIAN CHURCH
NATL ASSC OF CONGREGATIONAL
CHRISTIAN
NATIONAL BAPTIST CONVENTION OF
AMERICA
NATIONAL BAPTIST CONVENTION,
USA. INC.
NORTH AMERICAN BAPTIST
CONFERENCE
PRIMITIVE METHODIST CHURCH, USA
PROGRESSIVE NATL BAPTIST
CONVENTION,INC.
REFORMED CHURCH IN AMERICA
CHURCH OF GOD GENERAL CONFERENCE
SEVENTH DAY BAPTIST GENERAL
CONFERENCE
CHURCHES OF GOD, GENERAL
CONFERENCE
SCHWENKFELDER CHURCHES, THE
GENERAL CONF
SWEDENBORGIAN CHURCH, GENERAL
CONFERENCE
INDEPENDENT DENOMINATIONAL
ENDORSING AGY
ANGLICAN CATHOLIC CHURCH
CHURCH OF GOD OF PROPHECY
EPISCOPAL CHURCHES
EH INDEPENDENT FUNDAMENTAL CHURCHES
OF AMER
EJ FELLOWSHIP OF GRACE BRETHREN
CHURCHES
EK PLYMOUTH BRETHREN
EL REFORMED CHURCH IN THE UNITED
STATES
EM REFORMED EPISCOPAL CHURCH
EN REORGANIZED CHURCH OF LATTER DAY
SAINTS
EP CHURCHES OF CHRIST
FA JEWISH-REFORM
FB JEWISH-CONSERVATIVE
FC JEWISH-ORTHODOX
GA LUTHERAN CHURCH IN AMERICA
GB AMERICAN LUTHERAN CHURCH, THE
GC LUTHERAN CHURCH-MISSOURI SYNOD
GD EVANGELICAL LUTHERAN CHURCHES,
ASSC OF
HH HOLINESS CHURCHES
J0 NATIONAL ASSOCIATION OF
EVANGELICALS
JA CHRISTIAN AND MISSIONARY
ALLIANCE
JB CHRISTIAN CHURCHES & CHURCHES OF
CHRIST
JC CHURCH OF GOD (CLEVELAND, TN)
JD CHURCH OF THE UNITED BRETHREN IN
CHRIST
JE CHURCHES OF CHRIST IN CHRISTIAN
UNION
JF CONSERVATIVE BAPTIST ASSC OF
AMERICA
JG CONSERVATIVE CONGREGATION
CHRISTIAN CONF
JH ELIM FELLOWSHIP
JJ EVANGELICAL FREE CHURCH OF
AMERICA
JK EVANGELICAL FRIENDS ALLIANCE
JL EVANGELICAL METHODIST CHURCH
JM INTL CHURCH OF THE FOURSQUARE
GOSPEL
JN OPEN BIBLE STANDARD CHURCHES,
INC.
JP PENTECOSTAL CHURCH OF GOD OF
AMERICA,INC
JQ PENTECOSTAL HOLINESS CHURCH
JR MISSIONARY CHURCH, THE
JS GENERAL CONF OF THE BRETHREN
CHURCH
JT CENTRAL BIBLE CHURCH
JU FREE LUTHERAN CONGREGATIONS, THE
ASSC OF
JV ELIM MISSIONARY ASSEMBLIES
JW KANSAS YEARLY MEETING OF FRIENDS
JX MISSIONARY CHURCH ASSOCIATION
JY OHIO YEARLY MEETING OF FRIENDS
FOR OFFICIAL USE ONLY
Request For Appointment (Rev. 1/2012)
RFA GUIDE (RACE/RELIGION/ETHNICITY)
KF BAHA'I FAITH
KK EASTERN RELIGIONS
LA ASSOCIATE REFORMED PRESBYTERIAN
CHURCH
LB CUMBERLAND PRESBYTERIAN CHURCH
LC PRESBYTERIAN CHURCH IN THE US
LD UNITED PRESBYTERIAN CHURCH,
EVANGELICAL
LE ORTHODOX PRESBYTERIAN CHURCH,
THE
LF REFORMED PRESBYTERIAN CHURCH,
EVANGELICAL
LG UNITED PRESBYTERIAN CHURCH IN
THE USA
LH PRESBYTERIAN CHURCH IN AMERICA
LJ PRESBYTERIAN COUNCIL FOR
CHAPLINS & MIL
NA UNITED METHODIST CHURCH, THE
NB FREE METHODIST CHURCH OF NORTH
AMERICA
NC PRIMITIVE METHODIST CHURCH, THE
ND THE WESLEYAN CHURCH
NE SOUTHERN METHODIST CHURCH
QQ EUROPEAN-FREE CHURCHES
XC IGLESIA NI CHRISTO
XJ CHURCHES OF THE NEW JERUSALEM
YW WICCA (WITCHCRAFT)
ZB AGNOSTIC
Ethnicity
1 OTHHSP
2 USCANINDIAN
3 OTHASIAN
4 PR
5 FILIPINO
6 MEXICAN
7 ALASKA NATIVE
9 CUBAN
A AFRICAN
B CARIBBEAN
D INDIAN
E MELANES
F AUSTRALASIAN/ABORIGINE
G CHINESE
H GUAMANIAN
J JAPANESE
K KOREAN
L POLYNES
P EUROPEAN/ANGLO
Q OTHPACIS
S LATINAMER
T ARAB
V VIET
W MICRONES
Z DECLINED TO RESPOND
FOR OFFICIAL USE ONLY
Request For Appointment (Rev. 1/2012)