Service Academy Nominations

Full name: ________________________________________

Name of parent/guardian: ____________________________

Permanent address:
_____________________________________________________
City: ______________________ State :_______ Zip:_________

Temporary address (if different): _____________________________________________________
City: ______________________ State :_______ Zip:_________

Home Number: __________________ Mobile :_______________

Social security number: ______________ Date of birth: ___________

Please circle one: Male / Female

High school & year of graduation: ___________

Academy preference (Please rank 1-4 and only mark academies you are applying too):
Air force _____ Merchant Marine _____ Military ______ Navy ______

I have taken/will take the SAT or ACT on:_______________

SAT/ACT scores (SAT code: 0227/ACT code: 7193) ___________ GPA:__________

I will ask the following persons for letters of recommendation:
1. _____________________________________________________________________
2. _____________________________________________________________________
3. _____________________________________________________________________

I am also seeking a nomination through:

I am a citizen of the United States, or I will have attained citizenship before I enter the Academy. I am a legal resident of the State of Washington . I understand I must submit all necessary information by December 31st, 2008 to be considered for a nomination by Senator Maria Cantwell.
Signature __________________________