ROTC Scholarship Physical Fitness Test Form

ROTC Scholarship Physical Fitness Test Form
Use this form to register for and record an ROTC scholarship physical fitness test, including applicant details, test logistics, readiness screening, fitness results, and final evaluation.
Applicant Information
Full Name
First NameMiddle NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth
MonthDayYear
Date
Gender
Other
School or Institution Name
Test Event Details
ROTC Program/Unit Name
Test Date
MonthDayYear
Date
Test Time
Hour Minutes
AM/PM Option
Test Location
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Evaluator/Coordinator Name and Title
Physical Readiness and Health Screening
Current injury status
Medical restrictions or limitations relevant to physical exercise
Other
Cleared to participate in the physical fitness test
Fitness Test Components
Fitness Test Component Results
Rows Measured Value Pass Fail Notes
Run Time
Push-Ups
Sit-Ups
Plank Hold
Other Required Component
Run Time (minutes)
Push-Ups Count
Sit-Ups Count
Plank Hold Time
Hour Minutes
AM/PM Option
Overall Result and Notes
Overall Rating
Test Outcome
Evaluator Comments
Follow-Up Actions
Other
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