Military Academy Nominations Application Form

To request a Military Academy Nomination from my office, please complete the form below and mail to:

Office of Congressman Alan Nunnelee
Attn: Constituent Services
337 A East Main Street
Tupelo, MS 38804

Note: Please provide a picture with your nomination application

* indicates required field.

Name of Applicant

First Name:*

Middle Initial:

Last Name:*

Name you would like to be addressed by, if different:

Date of Birth:*

Social Security Number:*

Street Address:*

Address 2:

City:*

State:* Mississippi

Zip Code:* +4 (Determine your ZIP+4)

Gender:* Male Female

U.S. Citizen:* Yes No

If not, list your country of citizenship:

Parents/Guardians:*

Telephone Number:* Voice VP TTD

E-mail Address:*

Education Information

Name of High School:*

High School Street Address:*

Address 2:

City:*

State:* Mississippi

Zip Code:* +4 (Determine your ZIP+4)

GPA:*

Class Size:

Rank:

Graduation Date:

Would you like to be contacted by someone from an ROTC program? Yes No

If yes, please indicate which Mississippi university:

SAT Scores

Math:

Writing:

Critical Reading:

Composite:

ACT Scores

English:

Math:

Writing:

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

Please include a list of your extra curricular activities and leadership responsibilities:

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.