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Congressman Doug Lamborn 5th Congressional District of Colorado

U.S. SERVICE ACADEMY NOMINATION APPLICATION

HAND-WRITTEN APPLICATIONS WILL NOT BE ACCEPTED PLEASE USE FILLABLE FORM

Full Legal Name: ____________________________________________________________________________ First Middle Last

Birth Date: ________________ Age: _____ Birth Place: ____________________________________________

Home Phone Number: _________________________

City State

Cell Phone Number:

E-mail Address (ALL NOTIFICATIONS WILL BE SENT VIA EMAIL):___________________________________________

Permanent Address: _________________________________________________________________________ Street

________________________________________________________________________ City State Zip

Temporary Address (if living away from home): ____________________________________________________ Street

Phone Number:_________________ ____________________________________________________ City Zip

Father's/Guardian's Name: _____________________________ Phone:_________________________________

Address:___________________________________________________________________________________ Street City Zip

Father’s/Guardian’s Occupation: _______________________________________________________________

Employer: _________________________________________________________________________________

Mother's / Guardian's Name: _____________________________ Phone _________________________

Address (if different from above): ____________________________________________________________ Street City Zip

Mother's/Guardian's Occupation: _____________________________________________________________

Employer: _______________________________________________________________________________

Are you currently active in JROTC? Yes No

If yes, how long?__________ Rank __________________

Awards, commendations, medals? ________________________________________________________________

____________________________________________________________________________________________

____________________________________________________________________________________________

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Please indicate which Service Academies you are actively seeking to attend. IT IS VERY IMPORTANT that you list your preference for each academy (1st being first choice and 4th being last choice). Please do not choose an academy below unless you have begun or “intend to begin ” the pre-candidate process at the Academy. Please be aware that if you do not receive a nomination for your “1st choice” Academy, you may receive a nomination to your 2nd, 3rd or 4th choice Academy and to therefore be prepared to accept that nomination. Leave blank if you do not wish to receive a nomination for that particular Academy.

Air Force______ Military (West Point) ____ Naval (Annapolis) ____ Merchant Marine____

Have you been contacted directly by an academy? Yes No

If yes, which academy(s) and by whom and why? __________________________________________________________________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

What other sources are you currently seeking a nomination through? (It is in your best interest to request a nomination through all sources available to you)

___None ___ Senator Cory Gardner ___ Senator Michael Bennet ___ President ___ Vice President

Have you previously received a nomination from any of the above sources or the Congressman Yes No

If yes, for what class entry year? __________ What were the results? __________________________________

__________________________________________________________________________________________

__________________________________________________________________________________________

Is either parent a graduate from one of the Service Academies? Yes No

If yes, which academy: ________________________________

Is, or was, either parent a career military officer? Yes No

If yes, what branch of the service and what rank? __________________________________________________

__________________________________________________________________________________________

High School attended:__________________________________________ Year of Graduation: ________

High School Counselor: __________________ GPA (Un-Weighted) ________ Class Rank ___________

Phone Number: ___________________________ Email:____________________________________________

Standardized Test Scores: ACT COMPOSITE TOTAL: ___________ SAT TOTAL: _______________________

Have you attended any educational institution beyond high school? Yes No

If yes, where? What courses taken?

What book(s) are you currently reading?__________________________________________________________________

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SCHOOL ACTIVITIES Year

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Academic Distinction H.S. Ho nor Roll Nation al Honor Society Offic e Held: ______ ________ _____ AP or Honors Classes Academic awards or honors: _______________________________ _______________________________ _______________________________ _______________________________

Student Government Participation Student Council Office Held: ___________________ Class President Awards or honors: _______________________________ _______________________________ _______________________________ _______________________________

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Member School Clubs or Organizations

JROTC Highest Level of Leadership Held ______________________________ Awards or honors: _______________________________ _______________________________ _______________________________ ______________________________ Choir.................................................>Special Choir ....................................>Band .................................................>Special Band .....................................>Drama ...............................................>Speech and Debate ...........................>Matchwitz Team................................> Peer Tutoring ....................................>Peer Counseling ................................>School Clubs (such as German Club) ______________________________ Position: _______________________ ______________________________ Position: _______________________ ______________________________ Position: _______________________ ______________________________ Position: _______________________ ______________________________ Position: _______________________ ______________________________ Position: _______________________

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Other Awards and/or Honors__________________________________________ __________________________________________ __________________________________________

Service Clubs (i.e. 4H Club or Civil Air Patrol) _________________________________________ _________________________________________ _________________________________________ Awards or honors: _________________________________________ _________________________________________

Volunteer Work _________________________________________ _________________________________________ _________________________________________

Non-Profit Organizations _________________________________________ _________________________________________ _________________________________________

Scouting (list highest rank held and number of merit badges earned)

_________________________________________ _________________________________________ Awards or honors: _________________________________________ _________________________________________

Varsity Level Athletics __________________________ __________________________ __________________________ __________________________

Non-School Sporting Activities

__________________________ __________________________ __________________________ __________________________

Faith-Based Activities __________________________ __________________________ __________________________ __________________________

9 10 11 12

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Hobbies and Interests:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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WORK EXPERIENCES

If you are employed or have been employed during school or beyond, who is your employer?: _________________________________________________________________________________ _________________________________________________________________________________

What is your current position: ________________________________

How many hours per week do you work: After school: ________ In the summer: _________

Any other comments you might have about your work experience while in high school.

Please provide the names and addresses of the three individuals who will be providing your letters of recommendation. If you are home-schooled, or no longer in school, the previous statement does not apply (Submit letters from community leaders, pastors, school counselor, school principal, etc.)

1. Name:________________________________________

Address:_________________________________________________

City/Zip: __________________________ Phone:_____________________

1. Name:________________________________________

Address:_________________________________________________

City/Zip: __________________________ Phone:____________________

2. Name:________________________________________

Address:_________________________________________________

City/Zip: __________________________ Phone:______________________

Application Summary

Please check “Yes” or “No” to the following activities or achievements:

Varsity athletics

Community service

Captain/co-captain of sports team

Student body leader (elected)

National Honor Society

Church group member

Peer tutoring

Work experience (10 + hours per week)

Eagle Scout / Girl Scout Gold

JROTC / ROTC

Extreme hardship or adverse life experience

If yes, please explain:_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ______________________________________________________________________________

What type of degree are you wanting to achieve (what occupational field):_________________________________________________________________________

NoYes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

No

No

No

No

No

No

No

Return this application and all attachments to:

Nomination Coordinator:Elizabeth Tapia Email to: elizabeth.tapia@mail.house.gov

This is what your completed application packet should look like

How to assemble your application packet

Cover page: Your name above a recent photo Essay (Why do you want to attend a U.S. Service Academy) Application

High school transcripts & standardized test scores

3 Letters of recommendation (unless recommenders email directly) Important Note #1: If your letters of recommendation are not completed, you can submit your application packet

without them. However, you must instruct the three recommenders to send their completed letters to the Nomination Coordinator by September 25.

Doug Lamborn

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Essay

2Application

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High School Transcripts & Standardized

Test Scores

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Three Letters of

Recommendation

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5 pages

• Important Note #2: If your standardized test date has been postponed due to Covid-19, you can submit yourapplication without the test scores. Once you receive your test scores, please submit them to the NominationCoordinator as soon as possible.

• Compile all of the above documents in the correct order, scan to your computer, and email the entire packetto the Nomination Coordinator, Liz Tapia, at Elizabeth.Tapia@mail.house.gov

**Please do not attach this page to your application packet**