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 9, 2015.
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 9, 2015.
SIGNATURE ______DATE ______
The deadline for receiving completed applications is Friday, October 9, 2015. Please address any questions to Debra Poirot at 770-232-3032 or by email .