Service Academy Application

Your Information
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:
How Long Have You Been A Resident of Idaho?
Are Your Parents Legal Residents of Idaho?
Yes No
Gender:
U.S. Citizen?
Yes No
If not, list your country of citizenship:
* Please provide the names of your Parents/Guardians:
Are you are currently enlisted or have previous military service?
Yes No
Is either of your parents career military personnel?
Yes No
If yes, state branch, rank, and length of service:
Home Phone Number:
Cell Phone Number:
* Email:
Education Information
* High School:
* High School Address:
* City:
* State:
* Zip:
* GPA:
Class Size:
Class Rank:
Graduation Date:
Academy Information
Academy Preference: Indicate your preference in numerical order. Please do not designate any academy you would not accept. Due to the competitive nature of the nomination process, you may receive a nomination to the academy of your second, third, or fourth choice.
First
Second
Third

Fourth

Have you opened a pre-candidate file the academy (academies) you listed?

Yes No

If yes, which ones?



If no, you must contact the academies as soon as possible as your request for nomination will not be considered if you fail to open a candidate file with the academy (academies).
Have you applied to the United States Coast Guard Academy?
Yes No
Have you applied for the ROTC?
Yes No
Have you applied to the following nominating authorities?
Senator James E. Risch
Senator Mike Crapo
Vice President Mike Pence
Additional Information

EXTRACURRICULAR ACTIVITES:

Remember to include:
  • Special awards and honors with dates.
  • School and outside club memberships and activities, noting leadership positions and honors received, with dates.
  • Employment, both after school and in summer, with dates and hours per week.
  • Volunteer involvement, with dates and hours per week.
  • School athletics (note Captain, Varsity letter, MVP, All-League, etc.) with dates.
  • Out-of-school recreational athletics, with dates.

Name of home town paper?


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

Yes No

I certify that the information I have provided in the application is accurate.

By checking this box, I give Congressman Simpson and his staff permission to discuss my file with pertinent officials and to release my name to media if nominated.


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.

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