Service 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 service 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 Service 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 Friday, November 1, 2024. All materials should be sent to:

U.S. Representative 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.

Print This Form

You can print and sign this form after you click the Generate Form button. The address information is located on this page and also on the print preview page.