Academy Nomination Application

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Please complete the following application. Once you have filled out the form in its entirety, press the "Proceed to Next Page" button below. You will then be able to print your application in the correct format for submission.

Printed forms should be sent to the following address no later than November 1^st :

The Honorable Susan M. Collins

United States Senator

Attention: Academy Nominations Coordinator

One Canal Plaza

Portland, ME 04101

Additional details are provided within the "Service Academy Applicant Checklist" immediately following the printable application on the next page.

PERSONAL INFORMATION:

Name (first, middle, last):

Primary Telephone Number (xxx-xxx-xxx):

Cell Phone Number (xxx-xxx-xxx):

Home Address (street):

Town: Zip Code:

Maine County:

Mailing Address (if different from above):

Town: Zip Code:

Email address:

Social Security Number:

Date of Birth (mm/dd/yyyy):

Parents' or Guardians' Names:

HIGH SCHOOL INFORMATION:

High School:

High School Telephone Number (xxx-xxx-xxx):

Street Address of High School:

Town: State: Zip Code:

Date of Graduation from High School (mm/dd/yyyy):

GPA:

Rank in Class:

Number of Students in your class:

APPLICATION & NOMINATION INFORMATION:

List in order of preference academies to which you are applying:

Air Force

Army

Navy

Merchant Marine

Are you seeking a nomination from another source, and if so, which source?

Home of Record (for military dependents only):

REFERENCES:

Please list the names and addresses 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

Related Links

Washington, DC Office

Aroostook County Office

Bangor Office

Augusta Office

Lewiston Office

Portland Office

York County Office