U.S. Congressman Dan Webster | 11th District of Florida

Service Academy Information Form

Thank you for your interest in the U.S. Service Academies. As the Representative for Florida's 11th Congressional District, each year I have the privilege of nominating a limited number of people to the service academies. The honor of attending a service academy comes with an obligation and commitment to serve in the military for a minimum of five years upon graduation. For more information on seeking a nomination, please review my page of Frequently Asked Questions. Best wishes to you as you pursue your goal of attending one of the U.S. Service Academies and serving our country.

My office will begin accepting requests for Service Academy Nomination Packets on May 1, 2017. All nomination applications must be completed and returned by Friday, October 6, 2017.   To request a nomination packet, please complete the form below. 


Name:
First Name Middle Last Name

Permanent Address:
City: State: Zip:

Mailing Address:
(if different) City: State: Zip:

Email:
Phone:
SSN:
Date of Birth:
(Note: Applicant must be at least 17 years old, but not have passed his/her 23rd birthday)
County:

US Citizen:
(Note: In order to enter the academy, an applicant who received an appointment must be a United States citizen at the time of entrance to the academy)
Choice of Academy: Please indicate order of preference (1, 2, etc.) and only those academies from which you would accept a nomination
Air Force Merchant Marine Military Navy
Current Applications:
ROTC Applications: Have you applied for a ROTC scholarship?

Father's Name:
Work Phone:

Mother's Name:
Work Phone:

Residency: Do you or your parents reside in the 10th Congressional District?
(Note: Applicant must be a resident of the 10th District to receive a nomination from Rep. Webster)

High School:
Guidance Counselor:
Guidance Office Phone: