Kirsten Gillibrand United States Senator for New York

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Academy Nominations Application

To be considered for nomination, the following information must be fully and accurately completed. Any missing information could prolong the process or adversely affect your chances for nomination.

If we can offer any assistance, or if you have questions regarding the content of this form, please call our academy nominations department in my New York office at (212)688-6262

Personal Information

You will need to use this email address to complete the remaining steps of the application. We will also be sending updates about the academy nominations process to this email address.

Place of Birth

Contact Information
Parent(s) or Legal Guardian(s)

Parent(s) or Legal Guardian(s) cont.

Academy Preference

Please state your first choice and an alternate. If you do not wish to be considered for an alternate, please select the N/A option in the drop-down box.

Nominating Sources

Because securing a nomination does not guarantee an appointment or an offer of admission, the entire process is highly competitive. Currently each United States Senator is permitted to have a total of five vacancies charged to his or her office at each academy. You are therefore encouraged to apply for as many nominations as you may be eligible.

I have also applied to the following sources for a nomination: (please check)

Find your representative at www.house.gov.

Education

Secondary Education:

Post Secondary Education (if applicable):

Have you attended a service academy preparatory school or participated in a service academy foundation program?

Transcripts and Letters of Recommendation

To facilitate processing your application, please provide the name and contact information for the guidance counselor responsible for sending us your transcripts as well as the teachers, coaches, etc. who will be writing your letters of recommendation. Please obtain this information from your school and recommenders before submitting your application. Remember, we only accept 3 letters of recommendation, and at least one must come from a Math or Science teacher.

Guidance Counselor

Letter of Recommendation Writer #1

Letter of Recommendation Writer #2

Letter of Recommendation Writer #3

Standardized Testing:

Applicants are required to submit either a SAT or ACT, not both. However, if you would like to have both your SAT and ACT scores considered, please list all scores below.

ACT Scores

SAT Scores

Please note: The last acceptable SAT test is the October 11, 2014. The last acceptable ACT test is September 13, 2014. Also, be aware that our office does not engage in the practice of “Super Scoring” or “Score Choice.”

Honors and Awards

Please list all honors and awards received.

Extra-Curricular Activities

Sports

* If you intend to participate in this sport as a senior, please count senior year in years participated.

Clubs, Organizations & Volunteer Work

*If you intend to participate in this club or organization as a senior, please count senior year in years participated.

Work Experience:

* Please specify in the description whether this was a summer job, academic year job, or both.

Personal Statements

In the space below, please answer each of these essay prompts. Each of your responses should be less than 200 words. 1. Why do you want to attend a service academy and serve as an officer? 2. As servants of the nation, our military leadership must understand and respect the diverse values, perspectives, and experiences that make up America. How would you contribute to this diversity? 3. Select an issue that is of importance to you and discuss your views.

Certification

By their signatures below, a minor’s parent(s) or legal guardian(s) indicate, on behalf of their minor child, their full and unqualified consent to the terms of this Release.

If this Release is being granted with respect to a minor, it is necessary to obtain the consent of the minor’s parent(s) or legal guardian(s).

I HAVE CAREFULLY READ THIS RELEASE AND FULLY UNDERSTAND ITS CONTENTS.