Congressman Mike Quigley

Representing the 5th District of Illinois

Military Academy Nominations Application

Your Information

marks required fields of data.

Prefix:

First Name:

MI:

Last Name:

Suffix:

Social Security Number:

Date of Birth:

Street Address:

City:

State:

ZIP Code:

Gender:

Male Female

U.S. Citizen?

Yes No

If not, list your country of citizenship:

Parents/Guardians:

Contact Information

Email:

Phone Number / Type:

What are these options?
This is to help the constituents that are hard of hearing or use a video phone alert us to that fact so we can use the proper technology when we need to call them. The default option “Voice” is a normal audible telephone.

Education Information

Name of High School:

High School Street Address:

City:

State:

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 an appointment?

Yes No

Note:

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

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Congressman Mike Quigley

Representing the 5th District of Illinois

Military Academy Nominations Application

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Military Academy Nominations Application

Note:

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