Service Academy Nomination

Service Academy Nomination Application Packet 2015-2016 Congresswoman Corrine Brown Attn: Jackie Gray Military Academy Program Director 101 East Union Street, Suite 202 Jacksonville, FL 32202 Phone 904-354-1652 Fax 904-354-2721 Jackie.gray@mail.house.gov

ACADEMY APPLICANT'S INSTRUCTIONS READ THESE INSTRUCTIONS CAREFULLY AND REFER TO THEM OFTEN TO ENSURE YOU HAVE COMPLETED ALL REQUIREMENTS. ABSOLUTE DEADLINE FOR COMPLETED FILES IS December 11, 2015. Application Form: Complete the application form and return it to me as soon as possible. Have your high school guidance counselor complete the enclosed form and return it to me along with an up-to-date copy of your transcript. In addition to applying for a nomination, you must contact the Service Academies in writing or online so they can open a file on your behalf. Recommendations: A minimum of 3 personal recommendations are required, one of which must be from your guidance counselor or principal. Although not mandatory, it will be helpful to have letters from math, science, and English teachers and active duty or retired military personnel. These letters must be from persons who know you personally. (No relatives please). SAT/ACT Scores: Applicants are required to take the SAT and/or ACT exams. Dates, times, fees, etc., can be obtained from your guidance counselor. Make arrangements now to take these exams as soon as possible. Privacy Release: A privacy act release form must be completed by each applicant and their parent/parents. Medical Examination: A medical examination is required and will be given at no cost to you. The academy will schedule this exam at the appropriate time during your application process. Residency: A candidate must be a resident of the 5th Congressional District. A candidate who is temporarily residing outside the 5th District because their parents are involved in government service must prove legal residence within the 5th District and show that the move outside the District is temporary. The legal residence of the father normally determines residency. If the parents are divorced, the residence of the parent with whom the applicant lives determines their residency. Age: You must be at least 17 years old by July 1 of the year of your induction, but not have passed your 23 rd birthday. If you are applying for the Merchant Marine Academy, you must not have attained 25 years of age by July 1 of the year of entry. Transcripts: You must include an official high school transcript along with the form completed by the applicant s guidance counselor. If you have graduated from high school and attended classes at another school or university, you must include a transcript for those classes. Without this information included, your file will be considered incomplete. Recent Photo: Please staple a recent professional /graduation photograph of yourself to the first page of the application. Note: The completion of this application does not guarantee a nomination or appointment to the Service Academies. You will be considered for a nomination based on all your choices of academies as indicated on your application form. It is possible to receive a nomination to all your choices. In the interest of fairness to all candidates, every applicant must complete the requirements listed. Applicants who do not have a completed file by the December 11 th deadline shall be disqualified from further consideration. Remember, it is up to you to make sure your file is complete. Mail all materials to be included in your file directly to: Congresswoman Corrine Brown 101 E. Union Street, Suite 202 Jacksonville, FL 32202 Attn.: Jackie Gray PLEASE DO NOT SEND APPLICATION MATERIALS OF ANY KIND TO MY WASHINGTON OFFICE. GOOD LUCK!

PRIVACY CONSENT RELEASE FORM SPECIFICALLY FOR INQUIRY FOR POSSIBLITY OF APPOINTMENT TO A U. S. MILITARY ACADEMY To enable my office to make inquiries on your behalf, federal law requires that written consent be obtained from you prior to looking into your request. Because of the PRIVACY ACT OF 1974, information of a personal nature cannot be revealed to me without written permission. I, the undersigned, authorize Congresswoman Corrine Brown, or her representative, to obtain information relative to my being considered for an appointment to a U.S. Military Academy Applicant Age Applicant Signature Date DOB (month/date/year) SS# Address City State Zip+4 PARENT(S) PRIVACY RELEASE FORM I/We, the undersigned, authorize Congresswoman Corrine Brown, or her representative, to obtain information relative to my son/daughter being considered for an appointment to a U.S. Military, from whatever source (Federal, State, or Local authority) Father s Name Father s Signature Date Mother s Name Mother s Signature Date

APPLICATION FOR NOMINATION TO A U.S. SERVICE ACADEMY All pages of this application must be completed and returned with the applicant s signature. Please type or print legibly. Please indicate or rank which academy you would like to attend in the order of your preference, first to last. You must have an application on file with each academy. U.S. Air Force Academy U.S. Merchant Marine Academy U.S. Military Academy U.S. Naval Academy NOTE: It is highly recommended that you take time to research each of the service academies for more information. Full Name: (Last) (First) (Middle) Current Mailing Address: (Street/ P.O. Box) (City) (State) (Zip+4) Florida Residence: (If you listed a Post Office Box or a temporary address above, Service Academies require the listing of your street address in Florida.) (Street/ P.O. Box) (City) (State) (Zip+4) Home Telephone Number: ( ) - Cell Phone Number: ( ) - Social Security Number: - - E-mail address: Are you a U.S. Citizen? Gender: Male Female Date of birth: / / Height: Weight: **It is okay to use your name in press release after receiving a nomination or appointment? YES NO Unlike the other service academies, the Coast Guard Academy does not require a congressional nomination. To be considered for admission to the Coast Guard Academy, you must submit all application materials by February 1 of the year of entrance (November 1 of the year prior to entrance for Early Action).

APPLICATION FOR NOMINATION (CONTINUED) Name of parent(s) or legal guardian(s): (Mother) (Father) Mother s Phone: ( ) - Father s Phone: ( ) - Occupation: Address: Occupation: Address: Are you the child of an active or retired member of the United States Military? YES NO Are you the child of a deceased veteran, disabled veteran, prisoner of war, serviceman missing in action, or Medal of Honor Awardee? If yes, please specify: High School Attended: Please print (School Name) (School Address) (City) (State) (Zip) (School Phone Number) (Counselor s Name) Expected Date of Graduation: / / High School GPA: Class Rank: / (Please have your counselor convert this to the 4.0 scale) SAT: Critical Reading Math Composite ACT: English Math Reading Science Composite Have you attended any college? Yes No If yes, college attended: (School Name) (School Address) (City) (State) (Zip) Date Attended: Credit Hours Earned: Current GPA: Number of hours currently attending:

APPLICATION FOR NOMINATION (CONTINUED) If you have applied for a nomination through any other sources, please list here: Do you intend to make the military a career? Yes No High School Extracurricular Activities (Clubs, etc., of which you are or have been a member, number of years as a member and offices held): Athletics (list by grade and any letters/awards received): Community Activities (religious groups, scouts, community service, etc.): Employment (jobs you are holding or have held--include how long and job description): What are YOUR reasons for pursuing a nomination & subsequent appointment?

I have read the information sheet explaining nomination procedures and am familiar with the Congresswoman's requirements, including the December 11, 2015 deadline. I certify that I am a legal resident of Florida's 5th Congressional District and that there is no known reason why I should not be medically qualified to receive an appointment if nominated. DATE: Signature: Signature of Parent or Legal Guardian: If additional space is needed, please use a separate sheet of paper & attach it to this sheet.

EDUCATION EVALUATION THIS FORM MUST BE COMPLETED BY THE HIGH SCHOOL GUIDANCE COUNSELOR FOR THE CANDIDATE FOR NOMINATION TO ONE OF THE UNITED STATES SERVICE ACADEMIES. (Please Print) Name of Applicant: (Last) (First) (Middle) Name of School: Phone number of School (Include area code): ( ) - Numerical Class Rank of (Please indicate number ranked & size of class) Grade Point Average (not weighted) (Please convert this to the 4.0 scale) Please Indicate Date & Scores of SAT: Date Verbal Math ACT: Date Verbal Math English Please rate the following using a scale of 5 (below average) to 1 (outstanding) 1. Leadership Characteristics 5 below average 4 needs improvement 3 average 2 satisfactory 1 outstanding 2. Ability to work under pressure 5 below average 4 needs improvement 3 average 2 satisfactory 1 outstanding 3. Ability to get along with others 5 below average 4 needs improvement 3 average 2 satisfactory 1 outstanding General Comments and/or recommendations (your comments are most helpful) (If you need more room for any subject, please use another sheet of paper) Date Title Signature PLEASE RETURN THIS FORM AND A COPY OF THE STUDENTS FINAL JUNIOR OR SENIOR TRANSCRIPT TO: Congresswoman Corrine Brown ATTN: Jackie Gray 101 E. Union Street, Suite 202 Jacksonville, FL 32202 (904) 354-1652

Selection Criteria Nominations from Congresswoman Corrine Brown are based on a whole person evaluation. Applicants are considered for nomination based upon five levels of criteria. I. Academics: Evaluation of academic records will include the applicant s grade point average, SAT / ACT scores, class ranking, student s willingness to embrace academic challenges, and if applicable any college records. II. III. IV. Leadership: Consideration will be made based on the student s leadership experience and potential command ability. The consideration of this qualification will be based upon the applicant s records of extracurricular activities. Quality of involvement is stressed over the number of activities. Character / Motivation: Consideration of the motivation and desire of applicants to attend a service academy is based upon their recommendations, and their commitment toward the academy of choice. Medical / Physical: The academies schedule medical and physical fitness examinations. Students will be notified when and where to report for these tests. V. Competitiveness: The final consideration of an applicant for a nomination is comparative in nature, appraising each applicant s attributes against all others who are applying. If you have any questions please feel free to contact Jackie Gray at 904.354.1652 or Jackie.gray@mail.house.gov

MILITARY SERVICE ACADEMY INFORMATION The President of the United States, Vice President, Members of Congress and the Department of Defense has the authority to nominate persons for admission to a Service Academy. Applicants should direct any questions regarding the admissions process for a particular Academy to the Academy s Admissions office. Applicants are responsible for initiating a pre-candidate file at each Academy to which they are seeking a nomination. Contact information for each of the academies is listed below. United States Military Academy Director of Admissions United States Military Academy 606 Thayer Road West Point, New York 10996 (845)938-4041 or (800)822-2769 Website: http://www.usma.edu United States Air Force Academy USAFA / RRS 2304 Cadet Drive, Suite 200 USAF Academy, Colorado 80840 (800)443-9266 Website: http://www.academyadmissions.com United States Naval Academy Candidate Guidance Office United States Naval Academy 117 Decatur Road Annapolis, Maryland 21402 (410)293-4361 or (800)638-9156 Website: http://www.usna.edu United States Merchant Marine Academy Director of Admissions U.S. Merchant Marine Academy Kings Point, New York 11024 Website: http://www.usmma.edu * The U.S. Merchant Marine Academy uses state quotas to determine admission, rather than district quotas. For the Merchant Marine Academy, a Member of Congress may nominate as with other academies, however, there is no dedicated position available. Each nominee selected must compete statewide for the vacancies and the Merchant Marine Academy makes the selection.