Response

Application Form for Service Academy Nomination

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Applicant Information

* First Name

* Last Name

* Address Line 1

* City

* State

* Zip

* Phone

Cell Phone

* Email

Parents or Guardians including Address (if different from above)

Prefix

* First Name

* Last Name

Address Line 1

Address Line 2

City

State

Zip

* Email

* Phone

Applicant Information (cont)

* Social Security Number:

* Date of Birth:

* Are you a United States Citizen?

* Name of High School:

* Street Address:

* City:

* State:

* Zip:

* Class Rank:

* Class Size

* Cumulative Unweighted GPA:

* Expected Date of Graduation:

* SAT Reading:

* SAT Writing:

* SAT Math:

SAT Multiple Choice:

SAT Essay:

* ACT English

* ACT Mathematics:

* ACT Reading:

* ACT Science Reasoning:

* ACT Composite:

During test taking, please use SAT code 1685 and/or ACT code 7607 to have your official scores sent to the office of the Eleventh Congressional District of Ohio

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To which academies are you seeking a nomination?

U.S Air Force Academy:

U.S Military Academy (West Point)

U.S Naval Academy:

U.S Merchant Marine Academy:

Please only request a nomination to the academies to which you plan to apply. You must begin the application process at each academy before our office can nominate you. It is your responsibility to notify our office if these preferences change.
Every attempt will be made to nominate you for your first choice.

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You may also seek nominations from other sources. (Your United States Senators; the President of the United States who nominates children of military personnel; the Vice President of the United States; the Secretary of the Army, Navy or Air Force who nominates members of regular military, reserve components and participants in the ROTC). Have you applied for nominations from all the sources available to you?

If yes, who?

If no, why not?

Name of hometown newspaper or local news website:

* Is it okay to use your name in a press release if you receive a nomination or appointment?

* High School Transcript

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* Resume of Extracurricular Activities

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* Letters of Recommendation

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Letter of Intent and Test Scores

Upload FileNo file chosen

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APPLICATION AGREEMENT: Please read the following statements before signing the application, as your signature indicates your agreement with the following statements. If you do not include your signature, your application will not be considered for nomination:

IT IS MY SINCERE DESIRE TO ATTEND A U.S. SERVICE ACADEMY AND I INTEND TO PURSUE A VIGOROUS ACADEMIC COURSE OF STUDY IF APPOINTED. I UNDERSTAND THAT ATTENDING A SERVICE ACADEMY ALSO REQUIRES A MINIMUM OF FIVE YEARS OF MILITARY SERVICE FOLLOWING GRADUATION AND I FULLY COMMIT TO THIS RESPONSIBILITY. I AM A U.S. CITIZEN OR WILL BE BY JULY 1, 2022. I WILL BE AT LEAST 17 YEARS OF AGE, BUT NOT YET 23 YEARS OF AGE ON JULY 1, 2022. I AM NOT MARRIED. I AM NOT PREGNANT, NOR DO I HAVE ANY CHILD SUPPORT OBLIGATIONS. I AM A LEGAL RESIDENT OF THE 11TH CONGRESSIONAL DISTRICT OF OHIO.

I CERTIFY THAT THE INFORMATION I HAVE PROVIDED IN MY NOMINATION PACKET IS ACCURATE. ANY CHANGES TO THIS INFORMATION WILL BE REPORTED IMMEDIATELY. ADDITIONALLY, I UNDERSTAND THAT I WILL NOT BE CONSIDERED FOR A NOMINATION IF MY NOMINATION PACKET IS INCOMPLETE OR NOT SUBMITTED BY NOVEMBER 19, 2021 AT 5PM.

* Signature (Print Name)

* Date Signed:

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