NROTC APPLICANT FITNESS ASSESSMENT
OMB CONTROL NUMBER: 0703-0026
OMB EXPIRATION DATE: 01/31/2026
AGENCY DISCLOSURE NOTICE:
The public reporting burden for this collection of information, OMB-0703-0026, is estimated to average 3 hours and 35
minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and
maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding
the burden estimate or burden reduction suggestions to the Department of Defense, Washington Headquarters Services,
at
[email protected]. Respondents should be aware that notwithstanding
any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of
information if it does not display a currently valid OMB control number.
PLEASE READ THE FOLLOWING STATEMENT REQUIRED BY THE PRIVACY ACT OF 1974.
PRIVACY ACT STATEMENT
AUTHORITY: 5 U.S.C. § 301 (Authorizing Departmental Forms and Regulations); 10 U.S.C. § 2107 (Financial
Assistance Program); and Executive Order 9397 (Use of Social Security Numbers), and System of Records Notice(s)
(SORN) N01131-1.and N0180-3.
PURPOSE(S): The primary use of this information is for officials to administer the Naval Reserve Officers Training
Corps (NROTC) Program, and to set forth the terms and conditions, including military service obligations, under which
the Navy will be providing an NROTC scholarship. The information will be used to determine whether you qualify,
and should be nominated for, an NROTC Scholarship. If you are nominated, the information will be used to enroll you
into NROTC and will be used by the Navy in its management of the NROTC program.
ROUTINE USE(S): These records or information contained therein may be disclosed outside the Department of
Defense to officials and employees of the college or university in which you enroll, and those of the Veterans
Administration, and Selective Service Administration in the performance of their official duties related to enlistment
and reenlistment eligibility and related benefits. Other uses may include - Providing information to officials and
employees of the Department of Transportation, and other agencies of the Executive Branch upon request in relation to
the management of quality of military recruitment; the Department of Veterans Affairs and Selective Service
Administration in relation to enlistment or reenlistment eligibility; Federal, state or local agencies that maintain civil,
criminal and other relevant information pertaining to the letting of contracts; in response to an inquiry from a
congressional office of record for an individual; to the Office of Personnel Management (OPM) to carry out legally
authorized government-wide personnel management functions and studies; and to the General Services Administration
(GSA) for the purposes of records management under the authority of 44 USC § 2904 & 2906. Information provided
may be used to screen and select individuals to receive NROTC Scholarships, to maintain data on the NROTC
scholarship program, to compare to scholarship applicants from previous or subsequent years, and to provide academic
data and contact information to Navy activities and admissions officials at colleges and universities so they can contact
applicants for recruitment purposes. If you are nominated for an NROTC Scholarship, the information will be released
to the top five schools you indicated on your application. Your information and notification of status may also be
provided to your high school so they may assist with the final stages of the process. Information provided on this form
is protected by the Privacy Act and will not be released outside of the Department of Defense without your permission,
unless it comes with an exception to the Act, or one of the routine uses in 32 C.F.R. § 701.112,
https://www.navy.mil/privacy.asp, and the routine uses set forth here.
DISCLOSURE: Voluntary. However, failure to provide the requested information may result in ineligibility for,
and/or disenrollment from, the NROTC Program.
More information on the SORNS can be found at the following link(s):
http://dpclo.defense.gov/Privacy/SORNsIndex/DODComponentArticleView/tabid/7489/Article/6411/n01 131-1.aspx,
http://dpclo.defense.gov/Privacy/SORNsIndex/DODComponentArticleView/tabid/7489/Article/6410/n01080-3.aspx.
NSTC 1533/168 (04-23) PREVIOUS EDITIONS ARE OBSOLETE Page 1 of 2
RETURN COMPLETED SCORE SHEET TO LOCAL NAVY RECRUITER
Full Name (First, MI, Last) Social Security Number
Height (inches) Weight (lbs)
READ TO APPLICANT:
"You are about to take the Naval ROTC Applicant Fitness Assessment. The results of this test will be used in
the NROTC scholarship application process by demonstrating your level of physical fitness. You may cease
work when you have scored the maximum for any individual event. Otherwise, do your best on each event.
You have 25 minutes to complete the entire test. After you complete each event, the scorer will record your
score and the time the event was tested. If at any time you cannot continue to meet the timed requirements, the
test will be terminated."
Start Time:
Number of Push-ups completed in 2 minutes:
Timed forearm planks:
(Maximum 3:25 Male/3:14 Female)
1 Mile Run Time Minutes Seconds
End Time
Evaluator’s Signature:
Evaluator’s Printed Name:
Evaluator’s Title/Position:
Date Signed:
NSTC 1533/168 (04-23) PREVIOUS EDITIONS ARE OBSOLETE Page 2 of 2
