APPLICATION FOR NOMINATION TO MILITARY ACADEMY

Please designate academy, or if you are applying for more than one academy, indicating first choice, second choice, third choice:

Air Force Academy ____                        West Point Military Academy  ____
Naval Academy       ____                        Merchant Marine Academy     ____

Receipt of this application is not to be considered as a commitment that the applicant will be nominated.  This office receives many more applications that it has openings.  This form is intended to aid in making selections and to make available at all times a record of all interested young persons.

First, Middle, Last Name:________________________________________________________________

Permanent Home Address:____________________________________________________________
                                                Street or RFD                                City                               Zip Code

Home Telephone:  (___) __________ Social Security Number:  ________ - ______ - _______

Date of Birth:  ____ / ____ / ____     Present Age:  _____           Uncorrected Visual Acuity:  ________

Names of Both Parents or Guardians: __________________________________________________

Prep or High School:  __________________________ School Telephone Number:  (____) __________

Counselor:  _______________________________________   Date of Graduation: ____ / ____ / ____

College, if Attending: ________________________________________________________________

Extra-Curricular Activities: ____________________________________________________________

Athletic Activities: ___________________________________________________________________

Honors Received: ___________________________________________________________________

Work Experience:___________________________________________________________________

Check One and Complete:
____  I have taken the following test on the dates indicated:   SAT _____  ACT _____
____  I have not taken the required tests, but plan to take:     SAT / ACT on ______

I am also seeking nomination through:  _______________________________________________________
                                                                        (Senator, Congressman, Vice-President, etc.)

PLEASE READ BEFORE SIGNING:

I CERTIFY THAT I AM A LEGAL RESIDENT OF THE SEVENTH DISTRICT OF MINNESOTA.  IF I HAVE NOT SUBMITTED ALL NECESSARY DATA BY THE DEADLINE, I UNDERSTAND THAT I WILL NOT BE GIVEN CONSIDERATION FOR A NOMINATION.

DATE:  __________      SIGNATURE:  _____________________________________________

It will be necessary for you to furnish to this office the following information:

1.        This application completely filled out and returned.

2.        A transcript of your high school academic record.  Please include your class rank, number in graduating class, and your grade point average.

3.        ACT or SAT scores at the earliest possible date.

4.        Two letters of recommendation.  These may be from teachers, employers, or other persons who are well acquainted with you.

5.        Your own letter explaining why your regard yourself as a good candidate for an academy appointment.

RETURN COMPLETED APPLICATION TO:
Congressman Collin Peterson, 714 Lake Avenue, #107, Detroit Lakes, Minnesota 56501