Application for Nomination
to the U.S. Service Academies

 

PLEASE TYPE OR PRINT LEGIBLY

Rank U.S. Service Academies in order of preference:

________  U.S. Military Academy

________  U.S. Naval Academy

________  U.S. Air Force Academy

________  U.S. Merchant Marine Academy

 

PERSONAL INFORMATION

Full name: __________________________________  Today’s Date:___________

Parent(s) or Guardian(s): _____________________________________________

Social Security Number: ______-____-______ Date of birth: __________________

Sex:  Male: ________  Female: ________

Permanent Address:

_____________________________

_____________________________

_____________________________

Temporary Address:

_____________________________

_____________________________

_____________________________

Permanent Phone: ________________ Temporary Phone: ___________________

 

ACADEMIC INFORMATION

High School: _______________________________________________________

Date of Graduation: _______________________  GPA: _____________________

Approximate class standing: __________  In a class size of: _________________

ACT Scores:  

English: ________  Math: ________  Reading: ________

Science Reasoning: ________  Composite Score: ________

SAT Scores:  

Verbal: ________  Math: ________

 

ACTIVITIES AND AWARDS

Athletic activities and awards (use back of page for any additional space necessary):

__________________________________________________________________

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Non-athletic school activities and awards (National Honor Society, clubs, cheerleading, drama, etc.) (use back of page for any additional space necessary):

__________________________________________________________________

__________________________________________________________________

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Activities outside of school (work, scouting, church, community, etc.) (use back of page for any additional space necessary):

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

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STATEMENT

In 50 words or less, please state why you wish to enter one of the U.S. Service Academies:

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

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CERTIFICATION

Please read before signing: I have read the Guidelines explaining the Senator's nomination procedure and am familiar with the requirements. If I have not submitted all necessary data by the October 31st, deadline, I understand that I may not be given final consideration for nomination.

Signature: _____________________________________  Date: _____________