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Get CC 228-R 2005-2021

GRANTS 33. ARMY COLLEGE FUND 34. PLUS APPLICANT S SIGNATURE COMMANDER S SIGNATURE CC FORM 228-R AUG 2005 PREVIOUS EDITIONS ARE OBSOLETE. APPENDIX - F FINANCIAL STATEMENT For use of this form see CC Pam 145-6 proponent agency is ATCC-PC DATA REQUIRED BY THE PRIVACY ACT OF 1974 Authority Principal Purpose Routine Use s Disclosure 10 USC 2101 2103 2104 2111 and 5 usc 301. 2 To obtain financial data in order to show financial solvency while participating in the Senior ROTC program* To provide information concerning a cadet s/applicant s financial status while participating in the Senior ROTC program* Disclosure is voluntary. However failure to provide complete information and provide responses may result in a disapproval of the requested action* PART I - PERSONAL DATA 1. NAME Last First MI 1a* SSN Last 4 digits PART II - ASSETS Enter the dollar amount round any cents to whole dollars beside each item that applies. 2. SAVINGS Savings Account Money Market Account IRA 3. BONDS STOCKS Investments 4. COLLEGE TRUST 5. MOTOR VEHICLES No Lein-Holder 6. OTHER i*e* Motorcycle Rental Property 7. TOTAL ASSETS PART III - COLLEGE LIABILITIES 8. RENT/MORTGAGE Apartment/House 8a* LIVE WITH PARENTS/FAMILY Enter an amount if thtere is a cost NOTE If item 8 or 8a is 0 explain why 9. UTILITIES Electric Water Telephone Cable Gas 10. MONTHLY FOOD EXPENSE 11. MEDICAL EXPENSE Outstanding Medical Bills 12. MONTHLY CLOTHING EXPENSE 13. INSURANCE Life Medical 14. INSURANCE Auto Motorcycle Home Renters 15. CAR OPERATING EXPENSES Maintenance 16. CAR PAYMENT 17. TOTAL LOANS/DEBITS Outstanding Bills VISA Credit Cards 18. MISCELLANEOUS EXPENSES i*e* Entertainment 19. CHILD SUPPORT Dependent child under age 18 20. OTHER 21. TOTAL MONTHLY DEBTS PART IV - INCOME UPON ENTRY INTO THE ARMY ROTC PROGRAM GROSS MONTHLY 22. FREE ROOM BOARD Check the appropriate box Yes No 23. SCHOLARSHIP Other than ROTC 24. WORK STUDY 26. STUDENT LOANS 27. STIPEND 28. APPLICANT SALARY 29. MGIB CHAPTER 30 30. SPOUSE SALARY 31. ADDITIONAL MGIB 32. APPENDIX - F FINANCIAL STATEMENT For use of this form see CC Pam 145-6 proponent agency is ATCC-PC DATA REQUIRED BY THE PRIVACY ACT OF 1974 Authority Principal Purpose Routine Use s Disclosure 10 USC 2101 2103 2104 2111 and 5 usc 301. 2 To obtain financial data in order to show financial solvency while participating in the Senior ROTC program* To provide information concerning a cadet s/applicant s financial status while participating in the Senior ROTC program* Disclosure is voluntary. 2 To obtain financial data in order to show financial solvency while participating in the Senior ROTC program* To provide information concerning a cadet s/applicant s financial status while participating in the Senior ROTC program* Disclosure is voluntary. However failure to provide complete information and provide responses may result in a disapproval of the requested action* PART I - PERSONAL DATA 1. However failure to provide complete information and provide responses may result in a disapproval of the requested action* PART I - PERSONAL DATA 1. NAME Last First MI 1a* SSN Last 4 digits PART II - ASSETS Enter the dollar amount round any cents to whole dollars beside each item that applies. .

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