Service Academy Nominations

Full name: ________________________________________

Name of parent/guardian: ____________________________

Permanent address:

_____________________________________________________

City: ______________________ State :_______ Zip:_________

Temporary address (if different): _____________________________________________________

City: ______________________ State :_______ Zip:_________

Telephone number: __________________ Mobile :_______________

Social security number: ______________ Date of birth: ___________

Please circle one: Male / Female

High school & year of graduation: ___________

Academy preference (Please rank 1-4 and only mark academies you are applying too):

Air force _____ Merchant Marine _____ Military ______ Navy ______

I have taken/will take the SAT or ACT on:_______________

SAT/ACT scores (SAT code: 0227/ACT code: 7193) ___________ GPA:__________

I will ask the following persons for letters of recommendation:

1. _____________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

I am also seeking a nomination through:

I am a citizen of the United States , or I will have attained citizenship before I enter the Academy. I am a legal resident of the state of Washington . I understand I must submit all necessary information by November 9, 2007 to be considered for a nomination by Senator Maria Cantwell.

Signature __________________________