Response

SERVICE ACADEMIES (Please rank choices if choosing more than one.)

USNA

USAFA

US Military Academy (West Point)

Merchant Marine Academy

CANDIDATE CONTACT INFORMATION

Prefix

First Name

Last Name

Suffix

Address Line 1

Address Line 2

City

State

Zip

Cell Phone

Date of Birth

Gender

U.S. Citizen

PARENT/GUARDIAN INFORMATION

Parent/Guardian Name

Parent/Guardian Street Address

Parent/Guardian Address Continued

Parent/Guardian Town or City

Parent/Guardian State

Parent/Guardian Zip Code

PARENT/GUARDIAN 2 INFORMATION

Parent/Guardian 2 Name

Parent/Guardian 2 Address

Parent/Guardian 2 Address Continued

Parent/Guardian 2 Town or City

Parent/Guardian 2 State

Parent/Guardian 2 Zip Code

EDUCATION INFORMATION

High School Name

GPA

Class Rank

Graduation Date

SAT TEST SCORES

SAT Score Math

SAT Score Writing and Language

SAT Score Reading

SAT Score Composite

ACT TEST SCORES

ACT Score English

ACT Score Math

ACT Score Reading

ACT Score Science

ACT Score Composite

ADDITIONAL INFORMATION

Please list any family members who are active service members or Veterans

Please list any employment history, extracurriculars, community activities, or honors you would like us to be aware of.

Please list names/relationships to three attached letters of recommendation.

Please confirm that all required fields are completed. In addition, we require the following:

Three letters of recommendation
Official High School Transcript
SAT and/or ACT Scores
Resume
An essay stating why you want to attend a service academy (500 words or less.)

You have the option of attaching documents to this form, emailing them to Seamus.Buckley@mail.house.gov, or mailing them to:

Office of Congressman Stephen F. Lynch
One Harbor Street, Suite 101

Boston, MA 02210

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