Academy Nomination Application Form

Please rank the Academies in order of preference (1 - 4)

_____U.S. Naval Academy	_____U.S. Air Force Academy
_____U.S. Military Academy	_____U.S. Merchant Marine Academy

I. Personal Data

Full Legal Name:

SS#:

Legal Address:

Home Phone Number:

Date and Place of Birth:

High School:

Counselor:

Names of Parents/Guardian:

Address of Parents/Guardian:

Work Phone(s) or Parents/Guardians:

County of Legal Residence:

Congressional District:

College (if applicable):

Applying for Academy Class Entering the Summer of:

II. Activities:

Honors and Awards:

Clubs and Activities:

Athletics:

Elected Offices:

Jobs:

Other:

III. Attachments:

You are encouraged to attach a resume or list of honors and awards, activities or any other information you feel is pertinent to your application.

IV. Essay:

On a separate page, briefly state why you want to attend a service academy.

V. Signature:

This is to certify that I have read and understand the Academy Fact Sheet provided by Senator Bond and that the information I am submitting is accurate. I understand that my completed application form must be submitted by the December deadline in order for my application to be given full consideration by Senator Bond.

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Signature of Applicant                     Date