DA Form 5250 Rotc Scholarship - Reserve Forces Duty

DA Form 5250 - also known as the "Rotc Scholarship - Reserve Forces Duty" - is a Military form issued and used by the United States Department of the Army.

The form - often mistakenly referred to as the DD form 5250 - was last revised on August 1, 1983. Download an up-to-date PDF version of the DA 5250 below or request a copy through the chain of command.

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ROTC SCHOLARSHIP - RESERVE FORCES DUTY
For use of this form, see AR 145-1; the proponent agency is MILPERCEN.
Addendum to DA Form 3540 (DA Form 4386 (National Guard only)) acknowledging the
requirement to reimburse the US Government for financial assistance should the individual
fail to complete their military obligations.
I understand that as a member of a Reserve Component unit that if I am disenrolled from
the ROTC Program for breach of my scholarship contract (DA Form 597-3), I may be
ordered to serve in an enlisted status for the remainder of the unexpired portion of the
enlistment contract. Should I voluntarily (action initiated on my part, e.g., failure to
attend drill) or through misconduct (service terminated by the Army National Guard/
US Army Reserve, e.g., drug usage) fail to complete the required period of enlisted
service, I shall reimburse the United States in a dollar amount, plus interest, in accord-
ance with the following formula:
Unserved Portion Of This Enlistment Contract
Amount Due = Financial Assistance Provided X
Amount Of Time Of This Enlistment Contract
The interest added to this amount shall be the same as the current interest applied to the
Federal Guaranteed Student Loan Program.
SIGNATURE OF MEMBER OF RESERVED COMPONENT UNIT
SIGNATURE OF WITNESS
DATE
APD LC v1.01ES
DA FORM 5250, AUG 1983
ROTC SCHOLARSHIP - RESERVE FORCES DUTY
For use of this form, see AR 145-1; the proponent agency is MILPERCEN.
Addendum to DA Form 3540 (DA Form 4386 (National Guard only)) acknowledging the
requirement to reimburse the US Government for financial assistance should the individual
fail to complete their military obligations.
I understand that as a member of a Reserve Component unit that if I am disenrolled from
the ROTC Program for breach of my scholarship contract (DA Form 597-3), I may be
ordered to serve in an enlisted status for the remainder of the unexpired portion of the
enlistment contract. Should I voluntarily (action initiated on my part, e.g., failure to
attend drill) or through misconduct (service terminated by the Army National Guard/
US Army Reserve, e.g., drug usage) fail to complete the required period of enlisted
service, I shall reimburse the United States in a dollar amount, plus interest, in accord-
ance with the following formula:
Unserved Portion Of This Enlistment Contract
Amount Due = Financial Assistance Provided X
Amount Of Time Of This Enlistment Contract
The interest added to this amount shall be the same as the current interest applied to the
Federal Guaranteed Student Loan Program.
SIGNATURE OF MEMBER OF RESERVED COMPONENT UNIT
SIGNATURE OF WITNESS
DATE
APD LC v1.01ES
DA FORM 5250, AUG 1983

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