Service Academy Nomination Form

To request a Military Academy Nomination form my office, please complete the form below.

* indicates information that you need to provide.

Preferences

(Number in order of preference that you have or will apply for)

 
 
 
 


PERSONAL INFORMATION
*
*
*
*
*
*
 


CONTACT INFORMATION
*
 
*


PARENTS/GUARDIANS
*
*
*
 
*
 
*
*
*
 
*


ACADEMICS
*
*
*
I have taken the following tests on the date(s) indicated:
 
 
I have not taken the required tests, but I plan to take:
 

I have previously sought a nomination through (complete if applicable)
 
 
 

EXTRACURRICULAR ACTIVITIES
 
 


Athletics
List sport(s)and circle grade
Sport Participation
(JV/V/Extra-Cur?)
Captain/Co-Captain Grade
(9/10/11/12)


WORK EXPERIENCE:
 
 

 

*** Mandatory essay must be written on a separate piece of paper. In 300 words or less, please state why you want to attend one of the U.S. Service Academies. (See Information Sheet, Part IV)


LEGAL RESIDENCY CERTIFICATION

Please read before signing. I have read the See Information Sheet explaining the nominating procedure and am familiar with Congressman LoBiondo's requirements.

I CERTIFY THAT I AM A LEGAL RESIDENT OF THE 2nd CONGRESSIONAL DISTRICT OF NEW JERSEY. If I have not submitted all necessary data by the November 1st deadline, I understand that I may not be given consideration for a nomination.

PLEASE KEEP A COPY FOR YOUR RECORDS AND RETURN THE APPLICATION TO:

The Honorable Frank A. LoBiondo
Attn: Carole Monday
5914 Main Street
Mays Landing, NJ 08330