SERVICE ACADEMY NOMINATION APPLICATION

ROB WOODALL, MEMBER OF CONGRESS

SEVENTH CONGRESSIONAL DISTRICT OF GEORGIA

Thank you for your interest in an appointment to one of the United States Service Academies. A congressional nomination is not needed for the U.S. Coast Guard Academy.

Please complete this application and return it with the required attachments and recommendation letters to the following address by Friday, October 8, 2016.

Representative Rob Woodall

Attention: Debra Poirot

Gwinnett Justice and Administration Center

75 Langley Drive

Lawrenceville, Georgia 30046

Full Name: ____________________________________________________________ __________________________

Preferred Name: ________________________________________________________________________________

Permanent Local Address: _____________________________________________________________________

County: _____________________________

City: ____________________________ Zip Code: ________________________

Home Phone: ______________________________ Cell Number: _______________________________

Email: ________________________________________________________________

Temporary Address (if applicable) _____________________________________________________________

City and State: ___________________________________ Zip Code: ___________________________

Social Security Number _________/_________/________

Date and Place of Birth: _________________________________________________

Are you a U.S. citizen: Yes No

Gender: Male Female

Are you a resident of Georgia’s 7th Congressional District? Yes No

Mother’s name: ___________________________________________ Phone: __________________________________

Father’s name: ___________________________________________ Phone: __________________________________

Names and Addresses of all High Schools Attended:

Graduation Date: ____________ Class Rank: ____________________

Grade Point Average: __________

SAT: Verbal ___________ Math __________ Date Taken: ____________________

ACT: Composite ________________________ Date Taken: ________________

SAT/ACT SCORE VERIFICATION – ABOVE INFORMATION CERTIFIED BY:

__________________________________________ ________________________________

(Signature of Counselor or Principal) Date

College Attended (if applicable): ________________________________________________________________________

Mailing Address: __________________________________________________________________________________________

Major: _____________________________________ Years Attended: ___________________________________________

In order of preference, please list the Military Academies in which you have an interest (U.S. Air Force, U.S. Naval Academy, U.S. Military Academy, and U.S. Merchant Marine Academy):

First Choice: _________________________________________

Second Choice: _______________________________________

Third Choice: _________________________________________

Fourth Choice: ________________________________________

Have you submitted (or are you planning to submit) an application to any other nominating source, such as a U.S. Senator or the Vice President. If so, to who was this application made?

Have you requested that a pre-candidate file be initiated for you at any of the academies? If so, which one(s)?

Please include the following in your application packet:

1. A sealed transcript of your academic record from high school along with your SAT

and/or ACT scores.

2. Please provide three letters of recommendation from people who know you personally.

3. In three hundred words or less explain why you want to attend a Service Academy.

4. List your extracurricular activities, honors and awards.

4. Attach a recent photograph.

5. List any work experience including hours per week.

By signing the statement below, you acknowledge that you meet the above minimum qualifications. You also confirm: I hereby state that I am a United States Citizen and a legal resident of the Seventh Congressional District of Georgia. I understand that attending a service academy requires a minimum of five years of military service following graduation and I fully commit to this responsibility. In signing this application, I request that Congressman Rob Woodall consider my application for a Congressional nomination to one or more of the United States Service Academies. I understand and accept that the deadline for completed applications and all requested materials is October 8, 2016.

SIGNATURE _____________________________________________DATE ______________________

The deadline for receiving completed applications is Friday, October 8, 2016. Please address any questions to Debra Poirot at 770-232-3032 or by email .