US Service Application

APPLICATION FOR A NOMINATION TO A U. S. SERVICE ACADEMY

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PRIVACY ACT STATEMENT: Submission of the requested information constitutes authorization to release it to Congressman Silvestre Reyes, his academy advisory committee, and the academy admissions offices.

ACADEMY PREFERENCE: Be sure to fill out an application with the Admissions Office of each of the academies. It is strongly urged that you make alternate plans should you not receive a nomination / appointment.

* required entries

	Air Force *		Merchant Marine*
	Army *		Navy*

I am applying for the class entering the year : *

I. PERSONAL HISTORY:
SSN: *

Full Name: *

E-Mail Address: *

Permanent Address: * Zip *

Mailing Address:

Telephone: (home) * (work) (relative)

Date of Birth: * Place of Birth *

Height: Weight: Gender: *

Mother's Name *		Occupation
Father's Name *		Occupation

Is your uncorrected visual acuity in each eye at least 20/20?*

If No, is your corrected visual acuity in each eye at least 20/20?

What is the primary language spoken in your home?*

Are you on active duty, or on reserve in the armed forces ? *

If Yes, which service?

Any Dependents? Marital Status?

Are you a U.S. citizen? *
If NO contact the Field Force Member for your first choice academy

II. EDUCATIONAL HISTORY:

High School: * Date of High School Graduation *

Mailing Address: *

Telephone * GPA : Class Rank : (ie. 5/1000)
PSAT: Date :
SAT: Date :
2nd SAT: Date 2nd:
ACT : Date :
ACT 2nd: Date 2nd:

Principal: Counselor:

College: if Applicable

Mailing Address:

Years Attended: Hours Completed: GPA :

Telephone Major:

III. EXTRA CURRICULAR ACTIVITIES; HIGH SCHOOL AND/OR COLLEGE:

Activity:	Grade Level(s) During Which you participated	Office held or Any Special Recognition Award:
Band /Orchestra / Chorus	10 11 12
Computer Club	10 11 12
Debate/Speech/Drama	10 11 12
Drill Team	10 11 12
Girls/Boys State Delegate	10 11 12
Honor Society	10 11 12
Language Club	10 11 12
Merit Scholarship	10 11 12
R.O.T.C./Rifle Team	10 11 12
School Publication	10 11 12
School Service Club	10 11 12
Science/Math Club	10 11 12
Student Club	10 11 12
Other	10 11 12

Tell us why you selected the above activities and how you benefited from them.

IV. ATHLETIC ACTIVITIES; HIGH SCHOOL AND/OR COLLEGE

Activity:	Grade Level(s) During Which you participated	Office held or Any Special Recognition Award:
Baseball/ Softball	10 11 12
Basketball	10 11 12
Bowling	10 11 12
Cheerleeding/ Pom Pom	10 11 12
Football	10 11 12
Golf	10 11 12
Gymnastics	10 11 12
Skiing	10 11 12
Soccer	10 11 12
Swimming/ Diving	10 11 12
Tennis	10 11 12
Track and Field	10 11 12
Volleyball	10 11 12
Wrestling/Judo/Boxing	10 11 12
Other	10 11 12

Tell us why you selected the above activities and how you benefited from them.

V. COMMUNITY ACTIVITIES, HIGH SCHOOL AND/OR COLLEGE

Activity:	Grade Level(s) During Which you participated	Office held or Any Special Recognition Award:
Church Club	10 11 12
Civil Air Patrol	10 11 12
Scouting	10 11 12
Travel Club	10 11 12
Social Club	10 11 12
Computer Club	10 11 12
Volunteer Work	10 11 12
Other	10 11 12

Tell us why you selected the above activities and how you benefited from them.

VI. EMPLOYMENT HISTORY
if applicable

Place & Address of Employment
Job Title
Period of Employment
Motivation for Work

Place & Address of Employment ?
Job Title
Period of Employment
Motivation for Work

VII. MANDATORY ESSAY *

In 500 words or less, explain why you wish to attend a U.S. Service Academy. Describe any special circumstance in your individual or family history which you wish to be considered, or any additional information not covered in the application above.

VIII: PLEASE READ BEFORE SIGNING

I have read and understood the Privacy Act Statement. The answers provided are true and correct to the best of my knowledge. I understand that in addition to the above referenced information, I am also required to submit the following:

SAT and/or ACT test scores.
Three completed recommendation forms which must be sent directly to the Congressman's El Paso office by the author.

If I do not submit all the necessary data by the stated deadline, I understand that I may not be given final consideration for a nomination.

Signature: You sign by entering the last four digits of your social security number:*
Date*

After you click Submit, you will be able to review and print your application