Response

                                     Congressman Jim Banks
                        Third Congressional District of Indiana
                             Class of 2027 Academy Application

PRIVACY ACT STATEMENT: Submission of the requested information constitutes authorization to release it to Congressman Banks, his academy advisory committee, and the academy admissions offices.

DEADLINE FOR SUBMISSION: OCTOBER 14, 2022
**You must reside in the 3rd Congressional District to receive this nomination**

PERSONAL INFORMATION:

First Name

Middle

Last Name

Home Address:

City

State

Zip

Email Address:

Confirm Email:

Cell Phone:

Home Phone:

Sex:

Height:

Weight:

Date of Birth:

Place of Birth:

Mailing Address, if different from home address:

Mailing Address

City

State

Zip

Academy Preferences:
(Rank academies, for which you submitted an application, 1-4 according to your reference. If not applying there, leave blank)

United States Air Force Academy

United States Merchant Marine Academy

United States Military Academy (West Point)

United States Naval Academy

Other applications for nomination you have applied for (please check all that apply):

Senator Young

Senator Braun

Vice President

Other

If "Other" was selected input name of elected official here

FAMILY INFORMATION:

Father's Name:

Father's Occupation:

Mother's Name:

Mother's Occupation:

Legal Guardian:

Legal Guardian Occupation:

Is your corrected visual acuity in each eye at least 20/20?

Are you on active duty or in a reserve component of the armed forces?

If yes, which service?

Do you have any dependents (children or spouse)?

Are you a US Citizen?

EDUCATIONAL INFORMATION:

High School:

High School Address:

High School Phone Number:

Date of Graduation:

Grade Point Average/Scale:

Class Ranking: _______ of _______

COLLEGE/ PREPARATORY SCHOOL:

College/Preparatory School:

College/Preparatory Address:

Major:

Credit Hours Earned:

Grade Point Average/ Scale:

Date of Graduation:

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COLLEGE ENTRANCE EXAMINATIONS:
For an application to be considered complete, applicants are required to have taken the SAT or ACT at least once, prior to the application deadline of October 14, 2022.

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PLEASE READ BEFORE SIGNING:

I have read and understand the information provided in this application regarding the nominating process. 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 14, 2022. If I have not submitted all of the required information by the deadline, I understand that my application will be considered incomplete. I have answered all questions truthfully and to the best of my knowledge. I understand that any false information could result in me not getting a nomination. I also understand that filling out an application does not guarantee me a nomination, and a nomination does not guarantee an offer of admission to an academy. I also give permission for my name to be released to the media in the event that I am nominated by Congressman Banks.

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