**Senator Orrin Hatch**

**Application for Consideration as a Nominee to the United States**

**Military, Naval, Air Force or Merchant Marine Academy**

Full
Name:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(first) (middle) (last)

Social Security Number: \_\_\_\_\_\_\_-\_\_\_\_\_\_\_-\_\_\_\_\_\_\_\_
Birth date: \_\_\_\_\_\_\_/\_\_\_\_\_\_\_/\_\_\_\_\_\_\_

Telephone Number (\_\_\_\_\_) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Age\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Permanent
Address:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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Mailing Address (if different from permanent
address):\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

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Email:
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Father's Name\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Mother's
Name\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Are you a U.S. citizen?\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Place of
Birth \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

High School \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ County
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Class Rank \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ GPA
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Date of Graduation \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Visual
Acuity \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

ACT Scores: Math \_\_\_\_\_\_\_\_ Eng \_\_\_\_\_\_\_\_ Reading
\_\_\_\_\_\_\_ Science Reasoning \_\_\_\_\_\_\_\_

SAT Scores: Math \_\_\_\_\_\_\_\_ Verbal \_\_\_\_\_\_ Date of test
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

I am scheduled to retake test on
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Check the Academy for which you are applying. If more than one, indicate
order of preference:

Air Force \_\_\_\_\_\_\_\_\_ Naval \_\_\_\_\_\_\_\_\_ West Point
\_\_\_\_\_\_\_\_\_\_\_ Merchant Marine \_\_\_\_\_\_\_\_\_\_

You are encouraged to apply with both Senators and your Representative.
Indicate the other

members of the Utah Congressional Delegation with whom you have applied:

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Remember, all the following must be included in your packet: Send
information to:

1\. Formal application **Senator Orrin G. Hatch**

2\. Copy of ACT/SAT scores **8402 Federal Building**

3\. Transcript of high school credits **Salt Lake City, Utah 84138**

4\. List of school activities

5\. List of extracurricular activities

6\. Letter of recommendation or completed form from high

school principal or counselor and one of your teachers

SENATOR ORRIN HATCH

INFORMATION AND EVALUATION SHEET FOR SERVICE ACADEMY APPLICANTS

EXTRACURRICULAR ACTIVITIES:

\_\_\_\_\_ Boys' State/Boys' Nation \_\_\_\_\_ Eagle Scout \_\_\_\_\_
School Band/Chorus Other:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_ Girls' State/Girls' Nation \_\_\_\_\_ Boy Scout \_\_\_\_\_
Language or Sci Club \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_ President of Student Gvt. \_\_\_\_\_ Girl Scout \_\_\_\_\_
School Publication \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_ Other Student Office \_\_\_\_\_ School Club \_\_\_\_\_
Yearbook/Newspaper \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_ President of Class \_\_\_\_\_ Key Club \_\_\_\_\_ Community
Service \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_ Other Class Office \_\_\_\_\_ Jr. ROTC \_\_\_\_\_ After
School Employment \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_ Student Council Member \_\_\_\_\_ Non-school club \_\_\_\_\_
Summer Employment \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_ National Honor Society \_\_\_\_\_ Church Position
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

ATHLETICS: KEY - V (Varsity), JV (Junior Varsity), CH (Church) I
(Intramural), OTH (Other)

> [V JV CH I OTH]{.underline} [V JV CH I OTH]{.underline} [V JV CH I
> OTH]{.underline} [V JV CH I OTH]{.underline}

Baseball Football Skiing \_\_\_\_\_\_\_\_\_\_\_\_\_ Track
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Basketball \_\_\_\_\_\_\_\_\_\_\_ Gymnastics \_\_\_\_\_\_\_\_\_\_\_\_\_
Swimming \_\_\_\_\_\_\_\_\_\_\_\_ Volleyball \_\_\_\_\_\_\_\_\_\_\_\_\_

Hockey \_\_\_\_\_\_\_\_\_\_\_\_ Soccer \_\_\_\_\_\_\_\_\_\_\_\_\_\_
Tennis \_\_\_\_\_\_\_\_\_\_\_\_\_ Wrestling \_\_\_\_\_\_\_\_\_\_\_\_\_\_

Awards:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

DO NOT COMPLETE BELOW THIS LINE

INTERVIEWER COMMENTS:
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ACADEMY RATING: ( ) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Air Force ( )
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Navy

( ) \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ West Point ( )
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Merchant Marine

SENATOR ORRIN HATCH

8402 Federal Building

Salt Lake City, UT 84138

THIS FORM SHOULD BE COMPLETED BY EITHER HIGH SCHOOL PRINCIPAL OR HIGH
SCHOOL GUIDANCE COUNSELOR AND A TEACHER IN BEHALF OF A CANDIDATE FOR
SENATORIAL NOMINATIONS TO ONE OF THE UNITED STATES SERVICE ACADEMIES

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

NAME OF APPLICANT:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

First Middle Last

ADDRESS:
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NAME OF SCHOOL:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TELEPHONE NUMBER OF SCHOOL (include area code)
:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

APPLICANT'S YEAR IN SCHOOL: \_\_\_\_\_\_\_\_\_ (numerical) Class Rank
(Jr. R.) \_\_\_\_\_\_\_\_\_\_\_\_ G.P.A. \_\_\_\_\_\_\_\_\_

SAT SCORE: Verbal:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Math: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

ATC SCORE: English \_\_\_\_\_\_\_\_\_\_ Math \_\_\_\_\_\_\_\_\_\_\_\_\_
Reading \_\_\_\_\_\_\_\_\_\_ Science Reasoning \_\_\_\_\_\_\_\_\_

LEADERSHIP CHARACTERISTICS:
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DATE:
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SIGNATURE:
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TITLE:
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SENATOR ORRIN HATCH

8402 Federal Building

Salt Lake City, UT 84138

THIS FORM SHOULD BE COMPLETED BY EITHER HIGH SCHOOL PRINCIPAL OR HIGH
SCHOOL GUIDANCE COUNSELOR AND A TEACHER IN BEHALF OF A CANDIDATE FOR
SENATORIAL NOMINATIONS TO ONE OF THE UNITED STATES SERVICE ACADEMIES

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

NAME OF APPLICANT:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

First Middle Last

ADDRESS:
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NAME OF SCHOOL:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

TELEPHONE NUMBER OF SCHOOL (include area code)
:\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

APPLICANT'S YEAR IN SCHOOL: \_\_\_\_\_\_\_\_\_ (numerical) Class Rank
(Jr. R.) \_\_\_\_\_\_\_\_\_\_\_\_ G.P.A. \_\_\_\_\_\_\_\_\_

SAT SCORE: Verbal:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Math: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

ATC SCORE: English \_\_\_\_\_\_\_\_\_\_ Math \_\_\_\_\_\_\_\_\_\_\_\_\_
Reading \_\_\_\_\_\_\_\_\_\_ Science Reasoning \_\_\_\_\_\_\_\_\_

LEADERSHIP CHARACTERISTICS:
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