Service Academy Nomination

Please fill out the following form and print the document prior to submitting. You will need the printed version of this form as part of your mailed Service Academy file.

For more information about the Service Academy Application and Nomination process please click here for Frequently Asked Questions, or contact my Buffalo District Office.

Required fields are followed by *.

Your Contact Information

Prefix

First Name *

Last Name *

Suffix

Email Address *

Street Address *

City *

State *

Zip Code *

Phone Number *

Date of Birth *

Gender *

US Citizen * Yes
No

Country of Citizenship

Parent/Guardian Information

Parent/Guardian Name *

Street Address *

City *

State *

Zip Code *

Education Information

High School Name *

Street Address *

City *

State *

Zip Code *

GPA *

Class Size

Rank

Graduation Date

SAT Test Scores

Math

Writing

Critical Reading

Composite

ACT Test Scores

English

Math

Reading

Science

Composite

Academy Information

First Pick

Second Pick

Third Pick

Fourth Pick

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

Extracurricular Activities

Name of Hometown Newspaper

Is it ok to use your name in a press release? Yes
No