Response

Prefix:

First Name:

MI:

Last Name:

Suffix:

Date of Birth

Address Line 1:

Address Line 2:

City:

State:

Zip:

Cell Phone:

Phone:

Email:

Names of Parents or Guardians:

High School:

High School Phone:

High School Address:

Graduation Date:

GPA:

Rank in Class:

List in order of preference:

U.S. Air Force Academy:

U.S. Military Academy (West Point):

U.S. Naval Academy:

U.S. Merchant Marine Academy:

Are you seeking a nomination from another source, and if so, which source(s)?:

Test Scores:

SAT

SAT Math:

SAT Writing:

SAT Critical Reading:

SAT Composite:

Date taken:

ACT

ACT English:

ACT Math:

ACT Reading:

ACT Science:

Date taken:

Home of Record (for military dependents only):

REFERENCES:

Please list the names and addresses of three people who will be writing a reference for you. One of these must be from a principal, dean, teacher or guidance counselor at your high school or college. You are responsible for having the references submitted to me, or your file cannot be considered.

Reference(s)

Prefix:

First Name:

MI:

Last Name:

Address Line 1:

Address Line 2:

City:

State:

Zip:

Email:

Phone:

Attachments:

Letter of Intent:

Upload FileNo file chosen

Resume:

Upload FileNo file chosen

High School Transcript:

Upload FileNo file chosen

Official Test Scores:

Upload FileNo file chosen

Letters of Recommendation:

Upload FileNo file chosen

If you have any questions, please contact Myles Thompson in my office at myles.thompson@mail.house.gov.