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To request a Military Academy Nomination from my office, please complete the form below and mail to:
Office of Congressman Alan Nunnelee Attn: Constituent Services 337 A East Main Street Tupelo, MS 38804
Note: Please provide a picture with your nomination application
* indicates required field.
First Name:*
Middle Initial:
Last Name:*
Name you would like to be addressed by, if different:
Date of Birth:*
Social Security Number:*
Street Address:*
Address 2:
City:*
State:* Mississippi
Zip Code:* +4 (Determine your ZIP+4)
Gender:* Male Female
U.S. Citizen:* Yes No
If not, list your country of citizenship:
Parents/Guardians:*
Telephone Number:* Voice VP TTD
E-mail Address:*
Name of High School:*
High School Street Address:*
GPA:*
Class Size:
Rank:
Graduation Date:
Would you like to be contacted by someone from an ROTC program? Yes No
If yes, please indicate which Mississippi university:
Math:
Writing:
Critical Reading:
Composite:
English:
Reading:
Science:
Number your preference (1 to 4) of academies — with 1 being your highest preference.
U.S. Air Force Academy:
U.S. Merchant Marine Academy:
U.S. Military Academy(West Point):
U.S. Naval Academy:
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
Name of hometown newspaper:
Is it okay to use your name in a press release after receiving a nomination or appointment? Yes No
Please include a list of your extra curricular activities and leadership responsibilities:
You can print and sign this form after you click the Generate Form button. The address information is located on this page and also on the print preview page.