Military Academy Nominations Form

Instructions

Thank you for your interest in the U.S. Service Academies. Each year I have the privilege of nominating a limited number of people to four of the five service academies. The honor of attending a service academy comes with an obligation and commitment to serve in the military for a minimum of five years upon graduation.

For those seeking a military academy nomination you can find information here. Best wishes as you pursue your goal of attending one of the U.S. Service Academies and serving our country.

To request a Military Academy Nomination from my office, please complete the form below.

You will also need to submit:

  • A brief essay explaining why you want to attend an academy;
  • Two letters of recommendation, one of which must be from your high school;
  • A list of community activities, achievements and any employment;
  • A sealed copy of your high school transcript and your SAT or ACT scores (our identification number with the Educational Testing Service for the SAT test is 4775; for the ACT test, it is 7739).

The deadline for submission of materials to my office is November 1, 2019. All materials should be sent to:

U.S. Congressman Rick Larsen
Attn: Service Academy Nominations
2930 Wetmore Avenue, Suite 9F
Everett, WA 98201

* indicates information that you need to provide.



Your Information
Prefix: *
First Name: *
Middle
Last Name: *
Date of Birth: *
Social Security Number (No Dashes):

This form requires you to print, sign and mail, fax, or hand deliver the signed copy. Your social security number will not be transmitted electronically.
Address: *
City: *
State: *
Zip Code: *
Gender:
U.S. Citizen?
Yes No
If not, list your country of citizenship:
Please provide the names of your Parents/Guardians: *
Phone Number: *
Email: *
Education Information
High School: *
High School Address: *
City: *
State: *
Zip: *
GPA: *
Class Size:
Class Rank:
Graduation Date:
Test Scores

SAT Scores

Math:
Writing:
Critical Reading:
Composite:

ACT Scores

Math:
English:
Reading:
Science:
Composite:
Academy Information
Select your preference of academies — with "First" being your highest preference. Please rank only the Academies to which you intend to apply.
First
Second
Third

Fourth
 
An appointment to the Service Academies is based on a desire by the candidate to devote a lifetime of military service and implies recognition by the appointee of an obligation to the government to devote him / herself to a military career.

Are you interested in an appointment on that basis?

Yes No
Additional Information

Name of home town paper?


Is it ok to use your name in a press release after receiving an appointment?

Yes No

Note:

Please include a list of your extra curricular activities and leadership responsibilities.

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