Service Academy Nominations

Nomination Checklist

All applications are due by October 1, 2012. For questions please contact Andrew Gordon or Penny Forrest at (254)-732-0748

Please fill in below form.

* indicates required field.

Applicant Information

First Name:*

Full Middle Name:*

Last Name:*

Date of Birth:*

Social Security Number:*

Gender:* Male Female

Height:

Weight:

Contact Information

E-mail Address:*

Daytime Phone:*

Evening Phone:*

Best time to contact:*

Address in Texas

Street Address:*

Address 2:

City:*

State:* TX

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

Temporary address if currently outside district:

Street Address:

Address 2:

City:

State: (Select One) Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming

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

Academy Preference

I If you wish to be considered for more than one Academy, rank in order of preference, 1 being the most preferred and 4 being the least preferred.

Have you been contacted directly by an Academy? If yes, which Academy and who is your point of contact?

Parents/Guardian Information

Are either of your parents Active, Retired or Disabled Military? If so, give details*

Father or Guardian's Name:

Phone:

Mother or Guardian's Name:

Phone:

Are you applying for nomination from any other source?: President
Vice President
Senator Hutchison
Senator Cornyn

  *It is in your best interest to apply with multiple sources.

Are you a U.S. Citizen?:* Yes No

Are you a 17th Congressional District Resident?:* Yes No

Have you ever applied for a nomination in previous years?:* Yes No

Education Information

High School Name & Address:*

School telephone number:

Name of Principal and Counselor:*

Graduation Date:

GPA:

Class Rank:

Number of Students:

College Currently Attending:

College GPA:

Major:

Years attended:

Hours completed:

AP courses taken (if applicable)

AP test scores (if applicable)

Any additional explanations concerning your transcripts or test scores you want the Review Board to know about?

Are either of your parents Active, Retired or Disabled Military?

Do you have a pre-candidate Open at any Academy? Where and when did you apply?

Academic Awards or Special Achievements:

Athletic Activities - Grades 9-12 only

Non-Athletic Activities - Grades 9-12 only

List other non-athletic extracurricular activities and leadearship positions:

Non-athletic awards or special achievements:

Prior Service

Have you had any prior service with the military? (active/guard/reserve) Yes No
What Branch
Years Rank

Has a parent, grandparent, or sibling attended a service academy?" (name, academy, year of graduation)

Employment History

Employer/Company Name:

Supervisor Contact Info:

Dates of Employment:

Position:

Hours per week:

Essay #1

In 200 words or less, describe how you handled a difficult ethical choice you have had to make or a situation that tested your integrity. *

Essay #2

In 200 words or less, explain why you want to attend a Service Academy and explain how you have prepared yourself for the physical and academic rigor or a United States Service Academy. *