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Military Academy Nominations Form

Thank you for your interest in the U.S. Service Academies. Please complete the form below.

* indicates required information

Contact Information

First Name: *
Middle Name:
Last Name: *
Date of Birth: *
Social Security Number:
Street Address: *
City: *
State * and Zip Code*
Telephone No.: *
Gender: *
U.S. Citizen: *	Yes No
If not, list your country of citizenship:
Parents/Guardians: *

Education Information

Name of High School: *
High School Street Address: *
City: *
State , and Zip Code
GPA: *
Class Size/Rank	/
Graduation Date

Test Scores

SAT Scores
Math:
Writing:
Critical Reading:
Composite:

ACT Scores
English:
Math:
Reading:
Science:
Composite

Academy Information

Number your preference (1 to 4) of academies — with 1 being your highest preference

U.S. Air Force Academy:
U.S. Merchant Marine Academy:
U.S. Military Academy (West Point):
U.S. Naval Academy:

An appointment to the Service Academies is based on a desire by the candidate to devote a lifetime of military service and implies recognition by the appointee of an obligation to the government to devote him / herself to a military career. Are you interested in an appointment on that basis?
Yes No

Additional Information

Name of hometown newspaper:

Is it okay to use your name in a press release after receiving a nomination or appointment?
Yes No
NOTE: Please include a list of your extra curricular activities and leadership responsibilities.

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You can print and sign this form after you click the Generate Form button. The address information is located on this page and also on the print preview page.

Representative Marlin Stutzman

Representing the 3rd Congressional District of Indiana

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Military Academy Nominations Form

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