Application for U S Service Academy Nomination - Service by nicksils

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									         APPLICATION FOR U.S. SERVICE ACADEMY NOMINATION


Date:                                                                        Deadline: December 1, 2009

Personal Information of Applicant:

Social Security Number:                                       County:

Last Name:                              First Name:                                     Middle Initial:

Mailing Address:

VT Legal Residence or full physical address (if different from mailing address):



Home Phone:                                     Cell Phone:

Email:                                           Parent’s Email:

Full names of parent(s) and/or guardian(s):
Address(es) (if different):



 Age:             Gender:                             Date of Birth (yyyy/mm/dd):


 High School Name and City/Town:                      High School Telephone: (      )


 What Congressional offices have you ever             Have you asked your school to send a transcript to
 applied to?                                          Representative Welch?

                                                      When?

 Anticipated Graduation Date:                         Are you eligible for a Presidential Appointment?



List Academy preferences:

Rank, from 1st to 4th, the Academy (or Academies) for which you wish to be considered, crossing out
those that are not of interest to you. Mark only those Academies you have already contacted.

  ___ U.S. Military Academy                           ___ U.S. Naval Academy

  ___ U.S. Air Force Academy                          ___ U.S. Merchant Marine Academy
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         APPLICATION FOR U.S. SERVICE ACADEMY NOMINATION


Letters of Recommendation will be coming from:

(1) Name/Title:
    Address:
(2) Name/Title:
    Address:
(3) Name/Title:
    Address:

Cover Letter:
Enclose a one-two page cover letter to Representative Welch explaining why you want to attend your
desired Academy(ies) and why you deserve a nomination to that Academy.
Résumé/Activities List:
Enclose a résumé or list of your work experience, significant academic accomplishments, and
extracurricular activities through your school, church or community, especially those in which you have
assumed leadership roles.

Please Read and sign below:
I meet the nomination eligibility criteria on the enclosed list and I have contacted the admissions office for
each of the Academies checked above. I understand that in order to receive final acceptance by an
Academy, I must receive a nomination and pass the physical examination given by the Department of
Defense Medical Examination Review Board, and meet the specific admissions standards of the Academy
I wish to attend.


                                                               Applicant Signature

                                 MAIL TO: Representative Peter Welch
                                      30 Main Street, Suite 350
                                       Burlington, VT 05401
                                    Attn: Academy Nominations

NOTE: Our mail service is occasionally delayed by security precautions, so be sure to mail your
application materials to the Vermont office and call (802) 652-2450 before the following deadline to
confirm that all materials have been received.

                                            Deadline: December 1, 2009




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