From: ET2(AW) Mary P. Jones, USN, SSN (Last 4)
To: Commander, Naval Service Training Command (OD2/STA-21)
Via: Commanding Officer, (command name goes here)
Subj: APPLICATION FOR CONSIDERATION UNDER THE FYXX SEAMAN TO
ADMIRAL–21 COMMISSIONING PROGRAM
Ref: (a) OPNAVINST 1420.1B
Encl: (1) STA-21 Data Form (if not submitted via web page)
(2) Applicant’s Personal Statement of Desire for a
(3) Certified Copies of Evaluations (Last five observed)
(4) Certified Copies of SAT/ACT Results
(5) Certified Copy of ASTB scores (Pilot/NFO Option only)
(6) Certified Copies of High School Transcripts (or
explanation if missing) or GED Certificate (if
(7) Certified Copies of College Transcripts and Associate Degree Certificate(s) if applicable
(8) Certified Copy of SMART Transcript
(9) Certified Copies of Awards (include all Personal Citation Certificates and Awards Page NAVPERS 1070/880), Special Qualifications, additional documents, such as, (Letters of Recommendation, and Service wide Exam Profile Sheets(s)).
(10) Certified Copy of PFA Results (Last Three Cycles,
i.e. Spring and Fall 2010 and Spring 2011) Printed
from PRIMS. Most recent PRT must have been passed
with a minimum grade of GOOD or better. A grade of
SATISFACTORY or FAILURE in the most recent two PRTs
will make the applicant INELLIGIBLE.
(11) INTEL, IW, and OCEANOGRAPHY selectees must have a
current TS/SCI clearance or provide proof that TS/SCI
Clearance has been requested
(12) Photograph (Nuclear Option only)
(13) Nuclear - trained personnel assigned to a Nuclear
Training Command or holding a Nuclear NEC (335X,
336X, 338X, or 339X) applying to an officer
commissioning program (which includes STA-21), must
obtain a conditional release from Nuclear Field Duty
by submitting a NAVPERS 1306/7 to the Nuclear
Propulsion Program Management Branch, OPNAV (N133),
and their detailer (PERS-403). NAVADMIN 070/13
(14) Statement of Program Understanding (Page 13 for each
Option is required)
1. I hereby apply for consideration under the subject program and certify that I meet all requirements stipulated in reference (a).
2. Initial application data was submitted via web page on (date).
3. Enclosures 1 through (##) are forwarded to complete my application to the FYXX STA-21 Commissioning Program.
4. I, (name), if selected for appointment under the Seaman to
Admiral-21 Program, agree to enroll and complete an
Undergraduate degree at an NROTC-affiliated college or
university as assigned. I am applying for (list Primary
Option)and(Secondary Option if applicable).
a. I understand that I must incur a 6-year active service obligation prior to executing PCS orders to the assigned university. I understand that if I drop on request prior to commissioning I will be obligated for 5 years of enlisted service from the date of program disenrollment or the remainder of my current enlistment, whichever is longer. I also understand that if I complete degree requirements
, but fail to be commissioned, I will be obligated for 5 years of enlisted service from the date of program disenrollment.
b. I will accept an appointment as an Ensign
, USN, in the assigned officer community upon successful completion of my baccalaureate degree. I further agree to remain on active duty for a period of 5 years subsequent to acceptance of such appointment. I understand that, if selected for specialized follow-on training
, I will incur additional obligated service shown in reference (a).
5. My personal statement is enclosed as enclosure (2).
6. I understand that as per Section 6328 of Title 10, U.S. Code, time spent in school will not count for retirement. However, such active service shall be counted in computing the years of active service for all other purposes.
/S/ MARY P. JONES
(Signature is Required)