U.S. SERVICE ACADEMIES GUIDANCE COUNSELOR FORM
SENATOR MAX BAUCUS
This form must be completed by either your High School Principal or Guidance Counselor and sent to my Butte Office. The form will be used for assessment of potential nominees to one of the United States Service Academies.
NAME OF APPLICANT:________________________________________________
ADDRESS: ________________________________________________________
EMAIL: ___________________________________________________________
NAME OF SCHOOL:__________________________________________________
ADDRESS OF SCHOOL: _______________________________________________
SCHOOL TELEPHONE NUMBER:_________________________________________
APPLICANT'S YEAR IN SCHOOL:____Numerical Jr. Class Rank: ____(%)
GPA___SAT SCORE--VERBAL___MATH____
ACT SCORE--ENGLISH____MATH____
LEADERSHIP CHARACTERISTICS:________________________________________
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PERSONALITY TRAITS:________________________________________________
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ABILITY TO WORK UNDER PRESSURE:_____________________________________
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LIST SCHOOL ACTIVITIES IN WHICH APPLICANT PARTICIPATES:_________________
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GENERAL COMMENTS AND/OR RECOMMENDATION (Please complete this section as comments are most helpful):
__________________________________________________________________
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DATE:_____________SIGNATURE:________________________
TITLE: ______________________________
PLEASE SEND THIS FORM AND THE APPLICANT'S TRANSCRIPT TO MY BUTTE OFFICE: 125 West Granite Street; Suite 100: Butte, Montana 59701; ATTN: Kim Krueger kim_krueger@baucus.senate.gov
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