Military Academy Appointments
Fill out the application below online or download the application (PDF). Download the Adobe Acrobat Reader.

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Application for United States Service Academy Nomination
Asterisks indicate a required field.

Personal Information
Last Name:	*
First Name:	*  MI:
Date of Birth:	*[ 00 / 00 / 0000 ]
Social Security No.	* - no dashes
33rd District Address:	*
City: * County: Please Select Alameda Alpine Amador Butte Calaveras Contra Costa Del Norte El Dorado Fresno Glenn Humboldt Imperial Inyo Kern Kings Lake Lassen Los Angeles Madera Marin Mariposa Mendocino Merced Modoc Mono Monterey Napa Nevada Orange Placer Plumas Riverside Sacramento San Benito San Bernardino San Diego San Francisco San Joaquin San Luis Obispo San Mateo Santa Barbara Santa Clara Santa Cruz Shasta Sierra Suskiyou Solano Sonoma Stanislaus Sutter Tehama Trinity Tulare Tuolumne Ventura Yolo Yuba *
Home Phone: *  Daytime Phone:
Email Address :	*
Mailing Address: (if different) Same as Above
Address:
City: State: State AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip:
Parent’s Names:	*
Parent’s Address: (for parent not in same household):
City: State: State AL AK AZ AR CA CO CT DE FL GA HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA RI SC SD TN TX UT VT VA WA WV WI WY Zip:
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Educational Information
High School:	*
City:	*
Date of Graduation:	*
Counselor:  * Phone:
Grade Point Average: * or Class Standing: as  of (date)
If you are a high school graduate, complete the following:
College:
Major:
Credit Hours Earned  Grade Point Average:
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Scholastic Honors
Freshman:
Sophomore:
Junior:
Senior:
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Athletic Activities
(Please note varsity letters earned and leadership positions held.)
Freshman:
Sophomore:
Junior:
Senior:
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Medical
Have you ever had asthma or any other respiratory ailment?
Yes No
Explain:
Do you have 20/20 vision? Yes No
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Extracurricular activities
(Please include both school related and outside activities; note leadership positions held.)
Freshman:
Sophomore:
Junior:
Senior:
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College Entrance Examinations
ACT   1st  exam date:
2nd exam date:
SAT   1st  exam date:
2nd exam date:
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Employment History
Please list any part·time or full·time jobs you have held since you have been in high school:
Dates:   Employer  Hours per week
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Other Nominating Sources
Please check all other service academy nominating sources to which you are applying:
Senator Boxer    Senator Feinstein    Vice President

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