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U.S. SERVICE ACADEMIES GUIDANCE COUNSELOR FORM
SENATOR MAX BAUCUS This form must be completed by either your High School Principal or Guidance Counselor and sent to my Butte Office. The form will be used for assessment of potential nominees to one of the United States Service Academies. NAME OF APPLICANT:________________________________________________ ADDRESS: ________________________________________________________ NAME OF SCHOOL:__________________________________________________ ADDRESS OF SCHOOL: _______________________________________________ SCHOOL TELEPHONE NUMBER:_________________________________________ APPLICANT'S YEAR IN SCHOOL:____Numerical Jr. Class Rank: ____(%) GPA___SAT SCORE--VERBAL___MATH____ ACT SCORE--ENGLISH____MATH____ LEADERSHIP CHARACTERISTICS:________________________________________ __________________________________________________________________ PERSONALITY TRAITS:________________________________________________ __________________________________________________________________ ABILITY TO WORK UNDER PRESSURE:_____________________________________ __________________________________________________________________ LIST SCHOOL ACTIVITIES IN WHICH APPLICANT PARTICIPATES:_________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ GENERAL COMMENTS AND/OR RECOMMENDATION (Please complete this section as comments are most helpful): __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ __________________________________________________________________ DATE:_____________SIGNATURE:________________________ TITLE: ______________________________ PLEASE SEND THIS FORM AND A TRANSCRIPT SHOWING FINAL JUNIOR GRADES FOR APPLICANT TO MY BUTTE OFFICE: 125 West Granite Street; Suite 100: Butte, Montana 59701; ATTN: Kim Krueger
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