Congressman Brian Higgins

Representing the 26th District of NEW YORK

Service Academy Nomination

Please fill out the following form and print the document prior to submitting. You will need the printed version of this form as part of your mailed Service Academy file.

For more information about the Service Academy Application and Nomination process please click here for Frequently Asked Questions, or contact my Buffalo District Office.

Your Contact Information Prefix First Name * Last Name * Suffix Email Address * Address * City * State * Zip Code * Phone Number * Date of Birth * Gender * US Citizen *

Yes

Country of Citizenship

Parent/Guardian Information Parent/Guardian Name * Address * City * State * Zip Code *

Education Information High School Name * Address * City * State * Zip Code * GPA * Class Size Rank Graduation Date

SAT Test Scores Math Writing Critical Reading Composite

ACT Test Scores English Math Reading Science Composite

Academy Information First Pick Second Pick Third Pick Fourth Pick 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

Additional Information Extracurricular Activities Name of Hometown Newspaper Is it ok to use your name in a press release?

Yes

Congressman Brian Higgins

Representing the 26th District of NEW YORK

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