First Name * MI Last Name *
* Date of Birth:
SSN (No Dashes):
* Address:
* City:
* State:
 * Zip:
Gender:
* Please provide the names of your Parents/Guardians:
Home Phone Number:
Cell Phone Number:
* Email:


Education Info:
High School
Graduation Date
* Address:
* City:
* State:
 * Zip:
* GPA:
Class Size:
 Class Rank:






Academy Preference: Indicate your preference in numerical order. Please do not designate any academy you would not accept. Due to the competitive nature of the nomination process, you may receive a nomination to the academy of your second, third, or fourth choice.
First Second
Third Fourth








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


EXTRACURRICULAR ACTIVITES
Remember to include:
  • Special awards and honors with dates.
  • School and outside club memberships and activities, noting leadership positions and honors received, with dates.
  • Employment, both after school and in summer, with dates and hours per week.
  • Volunteer involvement, with dates and hours per week.
  • School athletics (note Captain, Varsity letter, MVP, All-League, etc.) with dates.
  • Out-of-school recreational athletics, with dates.

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

Name of home town paper?


The information above is correct. I am unmarried, not pregnant; have no child support obligation; and am a legal resident of the District. On July 1st of the year of my application, I will be an U.S. Citizen, and at least 17 but not 23 years of age.

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