Response

Military Academy Nomination Application

Complete and submit this application to be considered for a nomination from Representative Harder. A completed application for a nomination will include:

Current Photo (no selfies) (uploaded below)
Official High School Transcript + College Transcript if you have it (mailed to our office directly)
SAT Results or ACT Results (SAT 4417, ACT 7249) (or mailed directly to our office)
Resume with extracurricular activities and work experience (uploaded below)
Three letters of recommendation, one must be from a teacher or counselor (please either mail them to our office or have your recommender email them to our office)
A one-page statement stating why you want to attend the academy of your choice and why you should receive a nomination (uploaded below)

We must receive all application materials by the application deadline to be considered for a nomination. Please note information on a student's application or the process will only be released to the student directly. We will not be releasing information to parents. If you have any questions or want to confirm submission, please email our academy representative at Katie.Jaycox@mail.house.gov.

If you do not reside in the 9th Congressional District, you are not eligible for a nomination from Congressman Harder. Please go to Find Your Representative to find your congressional representative.

Personal Information:

First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip

Cell Phone

Home Phone

Mailing Address if different than above:

Sex:

Date of Birth:

Are you a U.S. Citizen?

Marital Status:

Parent or Guardian Information

Parent or Guardian

Phone Number

Mailing Address (if different from above):

Academic Information:

High School:

High School

High School Address

City

Zip

Graduation Date

Class Rank

Class Size

Grade Point Average/Scale

College Entrance Examinations:

*For an application to be considered complete an applicant must have submitted an official SAT or ACT score before October 31st to be considered for a nomination. *

ACT

Composite

Math

English

Reading

Science

Date Taken

SAT

Composite

Math

Verbal

Writing

Date Taken

College/ Preparatory School:

*If you have college credit, you must submit an official college transcript even if it's a transcript in progress*

College (if applicable)

City, State

Date of Attendance (from, to)

GPA

Credit Hours Earned

Major

Date of Graduation

Military Service, if any (include branch, rank, service number, and length of service)

Application History

Have you ever applied for a Congressional Nomination before?

If yes, what year and what was the outcome:

Please list any other nominating sources you are pursuing (President, Vice President, Senator):

Academy Information:

Rank, in order of preference, the Academies to which you have applied (rank using 1, 2, 3, and 4, with 1 being your top and 4 being your last choice. Only rank academies you would consider attending.)

West Point:

Naval:

Air Force:

Merchant Marine:

Into which branch of service would you like to commission?

Please indicate your application status:

US Military Academy:

US Naval Academy:

US Air Force Academy:

US Merchant Marine Academy:

What is your preferred major of study at an academy?

What is your preferred warfare specialty upon graduation?

Have you considered a career in one of the services beyond the service commitment?

If you do not get an appointment, do you have a Plan B? Have you applied to any other education/military opportunities available?

If Yes, please list the opportunities you applied to or considered:

*Please note that for each Academy you are requesting a nomination for, there must be an application on file with the Academy as well. You must have applied with the Academy by October 31st otherwise you will not be considered for a nomination. *

Are you a recruited athlete?

If yes, what sport and which Academy?

Do you have an offer of encouragement from an academy?

If yes, which Academy?

Medical Qualification:

Have you completed the academy medical examination with DoDMERB?

If "No," is it currently scheduled? YES (write the date)

If you have completed the medical examination, were you found fit for duty?

Candidate Fitness Assessment (CFA):

Have you completed the CFA?

If "No," is it scheduled? YES (write the date)

If "Yes," did you:

Who administered the CFA? Please write their name and position (coach, academy liaison, recruiter, etc.).

Please record the CFA scores below. If you do not remember the score, please write "Unknown".

Basketball Throw, Distance

Pull-Ups, Repetitions

Flexed Arm Hang, Time

Shuttle Run, Laps

Abdominal Crunches, Repetitions

Push-Ups, Repetitions

One Mile Run, Time

Extracurricular Activities

Please list your involvement in school and community activities in the listed categories. Include information relative to offices held, awards and honors received, and dates of participation. Please print neatly. This does not count as your professional resume.

Athletics:

Music and Drama:

School Activities, Societies, Clubs, and Offices Held:

Scholastic Awards and Honors:

Community Service/Volunteer Work:

Employment and Other Activities You Consider Important:

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Attach Resume

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Attach Photo

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I have read and understand that the information provided with this application regarding the nominating process, and I am familiar with the requirements. I certify that I am a citizen of the United States and a resident of the Ninth Congressional District of California. I affirm that I have never been convicted or arrested for violating a state or federal statute. I understand the deadline for my application is October 31st. If all the required components are not received by the District Office by the deadline, I understand that my application will be considered incomplete and therefore not considered for a congressional nomination. I release this information to the Office of Congressman Harder for use in the Service Academy Nomination Process. I release and authorize the Office of Congressman Harder to use, publish, reproduce, and distribute my name, likeness, image, voice, statements, and application materials, in whole or in part, for official congressional, informational, or communications purposes, including but not limited to public-facing materials. This authorization may include use across various media formats and platforms. I understand that no compensation is provided for such use.

Date Signed

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