Academy Nomination Application

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Academy Nominations

Note: Fields marked with an * are required.

First Name *

Middle Name *

Last Name *

Date of Birth *

County of Residence *

Congressional District *

Address (Street) *

Address 2

City *

State *

Zip *

Home Phone Number *

Cell Phone Number *

Mailing Address (If different from above)

Mailing Address 2

City

State

Zip

Email Address *

Parent/Guardian Full Name *

Parent/Guardian Phone Number *

Name of High School *

High School Enrollment Status *

Graduation High School Address *

Class Size *

Class Rank *

Class Rank % *

Current GPA *

Guidance Counselor *

Guidance Counselor's Phone Number *

Graduation Date *

SAT Composite

SAT Critical Reading

SAT Math

SAT Writing

ACT Composite

ACT English

ACT Math

ACT Reading

ACT Science

Academies To Which You Are Applying:

First Choice

Second Choice

Third Choice

Fourth Choice

All Academies - No Preference

REFERENCES:

Please list the names of three people that will be writing a reference for you. One of these must be from a principal, dean, teacher or guidance counselor at your high school or college. You are responsible for having the references submitted to me, or your file cannot be considered.

Senator Susan Collins

Academy Nomination Application

Academy Nominations

Related Links

Washington, DC Office

Aroostook County Constituent Service Center

Bangor Constituent Service Center

Augusta Constituent Service Center

Lewiston Constituent Service Center

Portland Constituent Service Center

York County Constituent Service Center