2021 Service Academy Nomination Application

Note: Fields marked with an * are required.

Personal Information

First Name *

Middle Name

Last Name *

Name you are known by, if different from your first name

Month of birth *

Day *

Year *

1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004

Gender *

Male Female

Mailing Address

Address *

City *

State *

----Military----,----States---- AA AE AP Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code *

Permanent Address

Same as mailing address

Address

City

State

----Military----,----States---- AA AE AP Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code

Contact Information

Email Address *

Best phone number to contact YOU *

(such as your personal cell phone)

Name of parent(s) or guardian(s) *

Parent or guardian's phone number *

Have you requested nomination before? *

Yes

No

Are you requesting a nomination for other members of the delegation? If so, who?

Have you been nominated to a military academy previously? *

Yes No

If so, which academy and by whom?

Are you a recruited athlete by this military academy?

Yes No

Florida County of Residence *

Alachua Baker Bay Bradford Brevard Broward Calhoun Charlotte Citrus Clay Collier Columbia Dade DeSoto Dixie Duval Escambia Flagler Franklin Gadsden Gilchrist Glades Gulf Hamilton Hardee Hendry Hernando Highlands Hillsborough Holmes Indian River Jackson Jefferson Lafayette Lake Lee Leon Levy Liberty Madison Manatee Marion Martin Monroe Nassau Okaloosa Okeechobee Orange Osceola Palm Beach Pasco Pinellas Polk Putnam Santa Rosa Sarasota Seminole St. Johns St. Lucie Sumter Suwannee Taylor Union Volusia Wakulla Walton Washington

United States Congressman that represents your home district *

Gaetz, Matt Dunn, Neal Yoho, Ted Rutherford, John Lawson, Al Waltz, Michael Murphy, Stephanie Posey, Bill Soto, Darren Demings, Val Webster, Daniel Bilirakis, Gus Crist, Charlie Castor, Kathy Spano, Ross Buchanan, Vern Steube, Greg Mast, Brian Rooney, Francis Hastings, Alcee Frankel, Lois Deutch, Ted Wasserman Schultz, Debbie Wilson, Frederica Díaz-Balart, Mario Mucarsel-Powell, Debbie Shalala, Donn

Academic Information

List each high school you have attended *

(in order of attendance)

Date of high school graduation? *

Name of guidance counselor *

Phone number for guidance counselor *

Address of high school you expect to complete. *

City *

State *

----Military----,----States---- AA AE AP Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip code *

GPA *

GPA Weighted or Unweighted *

Weighted Unweighted

Class Rank *

(indicate if your school does not rank students)

Number of students in your graduation class *

Enrollment status as of September 1, 2021 *

High school student Already graduated

If a high school graduate, please tell us your status

What are you currently doing.

Academic, Athletic, and Extracurricular Involvements

School Organizations

List all academic and extracurricular school-affiliated organizations in which you participated in high school. Include the years you participated in the organization and leadership positions you may have held. Do not use abbreviations; list full name of each organization.

Athletic Participation

List all athletic involvement, the number of years you participated and leadership positions you may held on the team.

Awards and Honors

List awards and honors you received and the year in which it was received.

Work Experience

List and briefly describe your work experience.

Volunteer Experience

List and briefly describe your involvement in volunteering.

Community Clubs and Organizations

List and briefly describe your involvement in community organizations.

Academy Leadership Seminar

If you have attended an Academy Leadership Seminar, list which one.

Academy Preference

This Application is for you to be considered at the four United States Service Academies: The Air Force Academy, Merchant Marine Academy, Military Academy/West Point, and the Naval Academy. Please order according to preference.  You will be considered only for those academies for which you have indicated an interest and in the order you have ranked them below.

First Choice *

Air Force Academy Military Academy/West Point Merchant Marine Academy Naval Academy

Second Choice

Air Force Academy Military Academy/West Point Merchant Marine Academy Naval Academy

Third Choice

Air Force Academy Military Academy/West Point Merchant Marine Academy Naval Academy

Fourth Choice

Air Force Academy Military Academy/West Point Merchant Marine Academy Naval Academy

Other Information

Have you ever been found responsible for a disciplinary violation at any secondary school you have attended, whether related to academic misconduct or behavorial misconduct, that resulted in your suspension, removal, dismissal, or expulsion from the institution? *

Yes No

Have you ever been convicted of a felony? *

Yes No

If you responded yes to either of the previous two questions, please explain.

Personal Responses

Please answer the following questions. Each response should be 5,000 characters or less.   

*Responses exceeding the 5,000 character limit will not be submitted successfully

Why do you want to attend a Service Academy? *

What characteristics do you possess that would enable you to excel in a Service Academy? *

Do you plan to pursue a career in military service? *

Have you overcome an obstacle that demonstrates your leadership abilities? If so, please describe. *

What military leader, either current or historic, do you admire and why? *

Please limit your response to one military leader.

Why should you be considered as a leader of character? *