Military Service Academy Nomination Application

Name*

(Full Legal Name)

First Middle Last

Parent/Guardian Name*

First Last

Parent/Guardian Name

First Last

Physical Home Address*

Street Address City State ZIP Code

Mailing Address*

Street Address City State ZIP Code

Email*

Phone*

Social Security #*

Date of Birth*

Place of Birth*

Height*

Weight*

Vision*

High School*

Year of Graduation*

Class Rank*

Class Size*

Estimated GPA*

If you have attended college, where?

How many years?

Area/Focus of Study

Athletic Participation & Extracurricular Activities

If High School, indicate grade level.

Sport Participation*

Important details to note: Grade, Played Varsity, Position, Letters, Were you Captain, Awarded any honors?

Extracurricular Activities

Select All That May Apply

Extracurricular Activities

Boys/State Nation

Girls’ State/Nation

Student Government

Class President

Other Class Office

Student Council Member

Church/Youth Group Club

Extracurricular Activities

Eagle Scout

Boy/Girl Scout

Officer, School Club

Key Club

Science Club

Office, Non-School Club

Language Club

Extracurricular Activities

School Band or Chorus

Jr. ROTC Officer

Jr. ROTC

Editor, School Paper, or Yearbook

Community Award

National Honor Society

Other Student Government Office

ACT & SAT

I have taken / am taking / am retaking the ACT & SAT

ACT Score

Date Taken*

SAT Score

Date

List Academy Choice In Order of Preference*

Academies: Naval, Air Force, Military (Army) Merchant Marine

I am also seeking a nomination from the Senate/Congressional office(s) of:

Please Read Before Signing

Information guide available by visiting: grijalva.house.gov/military-academy-nominations/

I have read the information sheet explaining the nominating procedure and am familiar with the requirements. I further certify that I am a U.S. CITIZEN. If I have not submitted all the necessary documentation on or before Thursday, October 31, 2024, I may not be given final consideration for an academy nomination.*

Essay Upload*

On separate pages, upload one page essays that answer the following questions: 1) Describe how attendance at a U.S. Military Academy will meet your career and personal goals? 2) Describe your extracurricular activities including honors, awards, affiliations, employment, special accomplishments, athletics, etc. 3) Why should the Congressman nominate you for such an exclusive opportunity?

Drop files here or

Max. file size: 256 MB, Max. files: 3.

Recent Photo/Headshot

This is optional and entirely at your discretion

Max. file size: 256 MB.