United States Service Academy
Application for Nomination
Representative Fred Upton
800 Ship Street, Suite 106
St. Joseph, Michigan 49085
(269) 982-1986
www.upton.house.gov
APPLICATION FOR NOMINATION
1. NAME: Click here to enter text.
(last, first, middle)
2. DATE OF BIRTH: Click here to enter text.
(year, month, day)
3. SOCIAL SECURITY NUMBER: Click here to enter text.
4. HOME ADDRESS: Click here to enter text.
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5. COUNTY IN WHICH YOU RESIDE: Click here to enter text.
YOUR HIGH SCHOOL: Click here to enter text.
6. HOME TELEPHONE NUMBER: Click here to enter text.
CELLULAR TELEPHONE NUMBER: Click here to enter text.
EMAIL: Click here to enter text.
CONTACT NUMBER AT COLLEGE/PREP SCHOOL: Click here to enter text.
7. NAME OF PARENT(S) OR GUARDIAN(S):
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8. ADDRESS, IF DIFFERENT THAN YOURS: Click here to enter text.
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9. ARE YOU A CITIZEN OF THE UNITED STATES OF AMERICA? Choose an item.
10. HAVE YOU, OR ARE YOU EXPECTING TO APPLY FOR A NOMINATION THROUGH ANOTHER SOURCE? Choose an item.
IF YES, PLEASE STATE OTHER SOURCE: Click here to enter text.
11. PLEASE LIST, IN ORDER, YOUR ACADEMY PREFERENCE:
Choose an item. ARMY
Choose an item. NAVY
Choose an item. AIR FORCE
Choose an item. MERCHANT MARINE
NOTE: YOUR “PREFERENCE” MAY BE CHANGED AS LATE AS THE DAY OF YOUR PERSONAL INTERVIEW.
Item 12: Proof of Residency
Please provide proof of residency for the 6th Congressional District in Michigan, by attaching a copy of one of the following documents:
- Valid Michigan drivers license
- Property tax documents
- Federal or Michigan Income tax documents
NOTE: FAILURE TO PROVIDE PROOF OF RESIDENCY WILL DISQUALIFY YOU FROM NOMINATION.
Item 13: School Related Extracurricular Activities: Please list all school related extra-curricular activities in which you have participated.
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Item 14: Outside Activities: Please list all activities in which you participated outside of school, such as civic work, church involvement, or any other activities not associated with school.
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Item 15: Work Experience
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Item 16: One Page Essay: Please write a ONE page essay in which you state your reasons for wanting to attend a United States Service Academy.