Congressman Lou Barletta

Representing the 11th District of Pennsylvania

Military Academy Nominations

Thank you for your interest in the United States Service Academies. As your representative in the United States House of Representatives, each year I have the privilege of nominating a limited number of students to our nation's service academies. Students who choose to pursue an appointment to one of the service academies are taking the first step towards a future of tough challenges, but great rewards. The academies combine a demanding educational curriculum with physical talent and personal responsibility to push students to reach their full potential as our nation’s future leaders.

For more information, please review my page of Frequently Asked Questions for those seeking a Military Academy Nomination, or to request a Military Academy Nomination form my office, please complete the form below.

All completed application materials need to be recieved by Friday, October 7th, 2016, by 5:00 PM.

* indicates a required field

Your Information

Prefix:

First Name:

MI:

Last Name:

Suffix:

Date of Birth:

Social Security Number:

Street Address:

Street Address Continued:

City:

State:

Zip Code:

Gender:

U.S. Citizen: Yes No

If not, list your country of citizenship:

Parents/Guardians:

Contact Information

Email:

Telephone Number:

Voice VP TTD

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 a nomination or appointment?
Yes No

NOTE:

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

Print This Form

You can print and sign this form after you click the Generate Form button. Once printed, please sign and send this form to my Harrisburg district office either by mail (4813 Jonestown Road, Suite 101, Harrisburg, PA 17109) or fax (717-695-6794). You will then recieve an academy application packet.

Congressman Lou Barletta

Representing the 11th District of Pennsylvania

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Military Academy Nominations

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ACT Scores

NOTE:

Print This Form

Washington, DC Office

Carlisle Office

Harrisburg Office

Hazleton Office

Sunbury Office