APPLICATION FOR
Date: Deadline: December 1, 2008
Personal Information of
Applicant: Social Security Number:
Full Name: (Last, First Middle Initial)
Mailing Address:
VT Legal Residence or full postal address (if different from
mailing address):
____________________________________________________ County:
Full names of parents and guardian: (and address if
different)
|
Home Phone: ( ) |
E-mail: |
|
Age:
Gender? Male or Female |
Date of Birth (yyyy/mm/dd): |
|
High School Name and City/Town: |
High School Telephone:
( ) |
|
Anticipated Graduation
Date: |
Have you asked your school
to send a transcript to Senator Leahy? When? |
|
What Congressional offices
have you ever applied to? |
Are you eligible for a Presidential
Appointment? |
Letters of Recommendation will be coming from:
(1)
Name/Title:
(2)
Name/Title:
(3)
Name/Title:
Rank, from 1st to 4th, the Academy
(or Academies) for which you wish to be considered, crossing out those that are
not of interest to you.
Mark only those Academies you have already contacted.
___
Activities List and Cover Letter:
Enclose a list of all your
extracurricular activities in school, church or the community, especially those
in which you have assumed leadership roles.
Also enclose a one page cover
letter to Senator Leahy explaining why you wish to attend the Academy(ies) you have selected
above.
Please Read and sign below:
I meet the nomination
eligibility criteria on the enclosed list and I have contacted the admissions
office for each of the Academies checked above.
I understand that in order to
receive final acceptance by an Academy, I must receive a nomination and
pass the physical examination given by
the Department of Defense Medical Examination Review
Board, and meet the specific admissions standards of the Academy I wish
to attend.
____
Applicant
Signature
MAIL TO: SENATOR PATRICK LEAHY