Service Academy Nominations Form

Military Academy Nominations

Note: Fields marked with an * are required.

Your Information

Prefix *

Ms. Miss Mr.

First Name *

MI

Last Name *

Suffix

Date of Birth *

Street Address *

Street Address (2)

City *

State

AL AK AZ AR CA CO CT DE DC FL GA HI ID IN IL IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Code *

Gender *

Male Female

U.S. Citizen? *

Yes No

If not, list your country of citizenship

Parents/Guardians *

Contact Information

E-mail Address *

Phone Number *

Phone Type *

Voice VP TTD

What are these options?
Constituents who are hard of hearing or use a video phone have the option to choose TDD or VP based on the type of device they are using. This allows our office to respond to them accordingly. The default option "Voice" is a standard audible telephone.

Education Information

Name of High School *

High School Address *

City *

State *

AL AK AZ AR CA CO CT DE DC FL GA HI ID IN IL IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY

Zip Code *

GPA *

Class Size

Rank

GraduationDate

Test Scores

SAT

Math

Writing

Critical Reading

Composite

ACT

English

Math

Reading

Science

Composite

Academy Information

Number your preference (1 to 4) of academies — with 1 being your highest preference.

U.S. Air Force Academy *

1 2 3 4

U.S. Merchant Marine Academy *

1 2 3 4

U.S. Military Academy *

1 2 3 4

U.S. Naval Academy *

1 2 3 4

An appointment to the Service Academies is based on a desire by the candidate to devote a lifetime of military service and implies recognition by the appointee of an obligation to the government to devote him / herself to a military career.

Are you interested in an appointment on that basis? *

Yes No

Additional Information

Name of "hometown" Newspaper

Is it okay to use your name in a press release after receiving a nomination or appointment?

Yes No

Please list your extra curricular activities and leadership responsibilities. *

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Print This Form

Use the "Submit" button below to produce the application for nomination. Please sign, scan, and send all documents by the first Monday in November of the current year.

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