Indicates required field Your InformationPrefix:- Select -Ms.Miss.Mr.First Name: MI: Last Name: Suffix:- None -2nd3rd4thIIIIIIVJr.DetailsDate of Birth:Show Date of BirthMonthMMJanFebMarAprMayJuneJulyAugSepOctNovDecDayDD01020304050607080910111213141516171819202122232425262728293031YearGender:FemaleMaleU.S. Citizen?YesNoIf not, list your country of citizenship:Your Contact InformationAddressAddressAddress 2CityState- Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingZIPEmail:TelephonePhone Number:Phone Type:- None -Standard voice telephoneVideophone [VP]Text-telephone device [TTD]phone textWhat are these options?Constituents who are hard of hearing or use a video phone have the option to choose TDD or VP based on the type of device they are using. This allows our office to respond to them accordingly. The default option 'Voice' is a standard audible telephone.Parent InformationParents/Guardians Name:Parent/Guardian Address:AddressCity/TownState/Province- None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingZIP/Postal CodeParent/Guardian Phone Number:phone textWhat are these options?Constituents who are hard of hearing or use a video phone have the option to choose TDD or VP based on the type of device they are using. This allows our office to respond to them accordingly. The default option 'Voice' is a standard audible telephone.Education InformationName of High School:High School Street Address:AddressAddress 2CityState- Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingZIPGPA:Class Size:Rank:Graduation Date:Please fill out all fields in either SAT or ACT scores.SAT ScoresEvidence-Based Reading and WritingMathComposite: 0 ACT ScoresMathScienceEnglishReadingComposite: 0 Academy InformationNew markupPlease rank your choice of service academy (1- most wanted, 4 least wanted). Only rank academies to which you have applied.First Choice:- None -U.S. Air Force AcademyU.S. Merchant Marine AcademyU.S. Military AcademyU.S. Naval AcademySecond Choice:- None -U.S. Air Force AcademyU.S. Merchant Marine AcademyU.S. Military AcademyU.S. Naval AcademyThird Choice:- None -U.S. Air Force AcademyU.S. Merchant Marine AcademyU.S. Military AcademyU.S. Naval AcademyFourth Choice:- None -U.S. Air Force AcademyU.S. Merchant Marine AcademyU.S. Military AcademyU.S. Naval AcademyI have applied to the following academies:Additional Information Extracurricular Activities:Name of hometown newspaper:Is it okay to use your name in a press release after receiving an appointment?YesNoFile UploadsResume:One file only.1 MB limit.Allowed types: pdf, doc, docx. Photo:One file only.2 MB limit.Allowed types: gif, jpg, jpeg, png. Essay:One file only.1 MB limit.Allowed types: pdf, doc, docx. CAPTCHA: enabled to secure this form. If you are having difficulty using Captcha's visual option, please visit the Accessibility page for more assistance.