About You

1. Salutation* -- Mr. Ms. Mrs. Miss Mr. and Mrs. Dr. Prof. Senator Gov. Congressman Hon. Fr. Sister Rabbi Reverend Fleet Admiral Admiral Vice Admiral Rear Admiral (upper half) Rear Admiral (lower half) Captain Commander Lieutenant Commander Lieutenant Lieutenant, Junior Grade Ensign Master Chief Petty Officer of the Navy Master Chief Petty Officer Senior Chief Petty Officer Chief Petty Officer Petty Officer First Class Petty Officer Second Class Petty Officer Third Class Seaman Seaman Apprentice Seaman Recruit Chief Warrant Officer Warrant Officer Sgt Major Of The Corps Sergeant Major Master Gunnery Sgt First Sergeant Master Sergeant Gunnery Sergeant Staff Sergeant Sergeant Corporal Lance Corporal Private First Class Private General of the Air Force General Lieutenant General Major General Brigadier General Colonel Lieutenant Colonel Major Captain First Lieutenant Second Lieutenant Chief Master Sergeant of the Air Force Command Chief Master Sergeant Chief Master Sergeant Senior Master Sergeant Technical Sergeant Senior Airman Airman First Class Airman Brother
2. • First Name*
   • Middle Name
   • Last Name*
3. • Phone Number*
   • Alternte Phone
4. • E-mail*
   • Verify E-mail*
5. • Date of Birth* January February March April May June July August September October November December
   •    01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31
   •    2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988
6. Place of Birth*
7. Social Security Number*

1. Street Address*
2. Street Address (2)
3. • City*
   • State* -- AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
   • Zip Code*

1. Name of High School*
2. Name of College/University (if applicable)
3. • Current GPA*
   • Current Class Rank (e.g. 10 out of 1000)*
4. • SAT Critical Reading Score*
   • SAT Writing Score*
   • SAT Math Score*
5. • ACT English Score*
   • ACT Math Score*
   • ACT Reading Score*
   • ACT Reasoning Score*
6. • Graduation Date* January February March April May June July August September October November December
   •   2014 2013 2012 2011 2010 2009 2008 2007 2006
7. Please list any sports in which you have participated:*
8. Please list any extracurricular or special activities in which you have participated:*
9. Please list any awards or recognition you have earned:*

Academy Information

1. Year you are requesting nomination: 2015 2014 2013 2012

2. Which of the academies are you interested in attending?*

   Please number according to your preference. You will be considered only for those academies for which you have indicated an interest, and in the order you have ranked them below.

   (Please note that congressional nominations are not accepted for the United States Coast Guard Academy in New London, Connecticut. Interested parties should contact the United States Coast Guard Academy directly at 1-800-883-USCG (8724) to apply.)

   • United States Air Force Academy
     Colorado Springs, CO
   • United States Merchant Marine Academy
     Kings Point, NY
   • United States Military Academy
     West Point, NY
   • United States Naval Academy
     Annapolis, MD

4. Have you already requested that a pre-candidate file be initiated for you at these academies? Please check

   YES NO
5. If yes, please indicate which academies

6. Have you requested a nomination from any of the following sources? (please check)

   • Senator
     Jack Reed
   • Congressman David Cicilline
   • Congressman Jim Langevin
   • President Barack Obama
   • Vice President Joe Biden

Essay

7. In the space provided, please write a 500-words-or-less essay describing why you are a good choice for a nomination to a United States Service Academy. Please be sure to include any information you feel has prepared you for this challenge and makes you stand out from the rest of the applicants.