**SERVICE ACADEMY INFORMATION**

Congressman Ed Perlmutter

12600 West Colfax, Suite B-400

Lakewood, Colorado 80215

Phone: (303) 274-7944

Fax: (303) 274-6455

NOMINATION APPLICATION FOR CLASSES ENTERING THE ACADEMIES

**APPLICATION DEADLINE: LAST FRIDAY IN SEPTEMBER**

Each year members of Congress nominate young men and women to become
eligible for an appointment to a U.S. Service Academy. The academies are
seeking future cadets and midshipmen who possess "whole person"
qualifications - - - good moral character, a commendable academic
record, evidence of strong leadership potential, physical aptitude,
medical fitness, motivation to achieve academically and eventually to
serve as an officer in the Armed Forces. Later this year I will make ten
nominations for each Seventh Congressional District vacancy at:

The United States Air Force Academy, Colorado Springs, Colorado

The United States Military Academy, West Point, New York

The United States Naval Academy, Annapolis, Maryland

The United States Merchant Marine Academy, Kings Point, New York

My nominations will be based on the recommendations of my Merit
Selection Committee which is made up of community representatives from
Colorado. The nominating process begins with the accompanying
application packet. All required forms and documents must be on file in
my office by the last Friday in September. If your file is complete at
that time, you will be scheduled for a personal interview with my Merit
Selection Committee. Seventh Congressional District interviews will be
held the last Saturday in October in my Lakewood District Office. I will
announce my nominations before the end of the year.

After my nominations have been submitted to the academies, the
Admissions Office of each academy will offer the actual appointments to
successful nominees. The announcement of appointments can begin as early
as January and will continue for several months until the ranks of the
next entering classes are full.

Because the nomination process is extremely competitive, be sure to
apply to all nominating sources available to you. Also, you should
indicate your alternative academy choices in case you don't receive a
nomination to your first academy choice. Give yourself the benefit of
every opportunity. Please read this application packet thoroughly and
follow instructions carefully. Don't hesitate to call my academies'
staffer, Bill Holen, with any questions or concerns.

Page 1

**SERVICE ACADEMY NOMINATION REQUIREMENTS**

To be eligible for an academy nomination from the Seventh Congressional
District:

You must be:

1.  a legal resident of the Seventh Congressional District of Colorado

2.  between the ages of 17 and not yet 22 on July 1^st^ of the academy
    class entering year

3.  a graduate of high school before July 1^st^ of the year of the
    entrance to an academy

You must submit the following documents to my Lakewood office before the
last Friday in September.

1.  an official application with photo attached. Do not substitute
    resume.

2.  concise (one page) answers to essay questions

3.  two personal letters of recommendation from teachers, employers,
    community leaders, church leaders, scouting, Civil Air Patrol, JROTC
    leaders or other adults who know you well (These two letters are IN
    ADDITION to the counselor's information on the school form)

You are responsible for directing the following documents to arrive at
my office before the September deadline:

1.  the school recommendation form (found in this packet) which must
    include your high school transcript bearing the official seal of
    your school or the signature and title of a school official

2.  your ACT( including the essay test)or SAT scores (to apply, you MUST
    have one or the other by the deadline)

To be eligible for a Congressional nomination and eventually to be
eligible for an appointment to a U.S. Service Academy, you MUST follow
two procedures at the same time:

CONSIDERATION FOR A CONSIDERATION FOR AN

CONGRESSIONAL NOMINATION: ACADEMY APPOINTMENT:

(Congressional Office) (Academy Admissions Office)

When your completed Congressional When each academy receives your

nomination application (included in completed pre-candidate
questionnaire

this packet) is received in my office, (which YOU MUST REQUEST from

I will establish and maintain a file in each academy), a file will be
established

your name in my Westminster office. and maintained in your name.

You may add information, letters of You may add information to your

recommendation, transcripts, ACT file at an academy, as instructed by

and SAT scores, etc. at any time each academy.

BEFORE the last Friday in September. **BE AWARE OF DEADLINES !**

**Keep in touch with my office! Keep in touch with academies!**

Page 2

**APPLICATION for NOMINATION to a UNITED STATES SERVICE ACADEMY**

**U.S. CONGRESSMAN ED PERLMUTTER**

**SEVENTH CONGRESSIONAL DISTRICT of COLORADO**

**12600 West Colfax, Suite B-400 attach photo**

**Lakewood, Colorado 80215**

**(303) 274-7944 approx. 2x2**

1\. APPLICANT'S
NAME\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(last) (first) (middle)

ADDRESS\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

(legal Colorado address)

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

(city) (state) (zip) (county)

PHONE [( )\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_]{.underline} SOC.
SEC.#\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

PARENTS' NAMES: DATE OF BIRTH\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

MOTHER\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
HEIGHT\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

FATHER\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
WEIGHT\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

PARENTS' LEGAL ADDRESS(ES) IF UNCORRECTED
VISION\_\_\_\_\_\_\_\_\_\_\_\_\_

DIFFERENT FROM ABOVE:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
CONTACTS YES?\_\_\_\_\_\_\_\_NO?\_\_\_\_\_\_\_

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

2\. NAME OF HIGH
SCHOOL\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_GRADUATION
YEAR\_\_\_\_\_\_\_\_\_\_\_\_

NUMERICAL CLASS RANK AFTER JUNIOR
YEAR\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

GPA AFTER JUNIOR
YEAR\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

SAT SCORES

READING\_\_\_\_\_\_\_\_\_\_\_\_MATH\_\_\_\_\_\_\_\_\_\_\_WRITING\_\_\_\_\_\_\_\_\_\_\_\_COMP\_\_\_\_\_\_\_\_\_\_\_\_\_

ACT SCORES

ENG\_\_\_\_\_\_\_\_MATH\_\_\_\_\_\_\_\_SOC.SCI.\_\_\_\_\_\_\_\_NAT.SCI.\_\_\_\_\_\_\_\_COMP\_\_\_\_\_\_\_\_\_\_\_\_\_\_

I have not taken an SAT or ACT test yet, but plan to
on\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Page 3

3.  I have received the following HONORS and AWARDS during my high
    school years:

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> (Use another page if you need additional space.)

4.  I have participated or held a LEADERSHIP role in the following
    activities (sports, clubs, church groups, scouts, community
    projects, etc.)

> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> (Use another page as needed.)

5.  My employment history follows:

> (employer) (date) description -- optional
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> \_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> \_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> \_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
> \_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> (Use another page as needed.)

6.  My academy choices in order of preference are: (list only those from
    which you would actually accept an appointment.)

> U.S. Air Force Academy (Colorado Springs,
> CO)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> U.S. Military Academy (West Point,
> NY)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> U.S. Naval Academy (Annapolis,
> MD)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> U.S. Merchant Marine Academy (Kings
> Point)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
>
> I am also seeking an academy nomination though the office of:
> (President, Vice President, U.S. Senators)
>
> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Page 4

ESSAY QUESTIONS

Your answers to these questions, combined with your application and all
other official records and documentation, will provide my Merit
Selection Committee with the most complete information to determine your
suitability for an academy nomination.

Your answers should reflect YOUR OWN BELIEFS and CONVICTIONS, not just
what you think someone else might want to hear. Feel free to do
research. Although the CONTENT of your answers is of greatest
importance, grammar, spelling, punctuation and writing style will also
be considered.

Please limit your answers to one (1) page single-spaced and answer all
four questions. When completed, attach your four essay pages to this
cover page with a paper clip, and return it with your application.

Please print the numbered questions with your answers on four separate
pages.

1.  **Are you planning on a military career? If "yes," in what field or
    area would you want to specialize as an officer? Please explain.**

2.  **What benefits do you expect to receive from attendance at a
    service academy rather than a civilian college or university?**

3.  **Under what circumstances, if any, do you think it would be
    appropriate to question or disobey the orders of a superior
    officer?**

4.  **If, as the commanding officer of a military unit in combat, you
    have taken prisoners-of-war, what humanitarian provisions should you
    know about the Geneva Convention and its applications to
    prisoners-of-war?**

    Page 5

APPLICATION SIGNATURE PAGE

I am a legal resident of the State of Colorado and of the Seventh
Congressional District.

I have read all of the information in the application packet and I am
aware of the procedure and requirements necessary for obtaining a
service academy nomination from U.S. Congressman Ed Perlmutter..

If I have not submitted ALL required documents to the Westminster office
of U.S. Congressman Ed Perlmutter by the deadline:

LAST FRIDAY IN SEPTEMBER

I understand that I will not be given further consideration for a
nomination this year.

SIGNATURE................................................................DATE...................

NOTE: Information submitted with your application cannot be returned.
Information submitted with your application is subject to the Privacy
Act of 1974, 5 U.S.C. Section 552(a), as amended and to the Freedom of
Information Act, Section 552, as amended.

Page 6

SCHOOL FORM

U.S. CONGRESSMAN ED PERLMUTTER

12600 WEST COLFAX, SUITE B-400

LAKEWOOD, CO 80215

UNITED STATES SERVICE ACADEMY NOMINATIONS

This recommendation form must be completed by the applicant's high
school principal or guidance counselor. Please send this completed form
and the applicant's official transcript directly to the address above
before the deadline on the last Friday in September.

NAME of
APPLICANT......................................................................................

(first) (middle) (last)

NAME of
SCHOOL...........................................................................................

SCHOOL
ADDRESS..........................................................................................

.......................................................SCHOOL PHONE \#
(......).............................

APPLICANT'S YEAR of
GRADUATION.................................................................

NUMERICAL CLASS RANK at END of JUNIOR YEAR.........
.......of.......................

GRADE POINT AVERAGE (GPA) at END of JUNIOR YEAR...
...............................

SAT
SCORES..................................................Verbal..............Math......................

ACT
SCORES..................Eng........Math........SocSci........NatSci........Comp.................

Please respond to the following questions. You may use another page if
needed. Thank you.

1.  How long have you known the applicant and in what setting?

2.  What is your overall assessment of this applicant as a candidate for
    admission to a service academy?

3.  Please describe any personal circumstances or characteristics that
    might affect the applicant's performance at an academy.

4.  Please describe and evaluate the applicant's leadership abilities,
    talents, strengths and limitations.

    SIGNATURE...............................TITLE....................DATE......................

    Page 7

APPLICATION PACKET CHECKLIST

Suggestion: Maintain a "*Service Academies*" file at home. Keep this
checklist in your

file to help you obtain documents, letters, etc., in advance of
deadlines.

+----------------------------------------+----------+-----------------+
| # REQUIRED DOCUMENT                    | ##       | ##              |
|                                        | DATE DUE |  DATE COMPLETED |
+----------------------------------------+----------+-----------------+
| Application form (with photo)          |          |                 |
| completed and                          |          |                 |
|                                        |          |                 |
| submitted to my office at: 12600 West  |          |                 |
| Colfax, Suite                          |          |                 |
|                                        |          |                 |
| B-400 Lakewood, CO, 80215.             |          |                 |
+----------------------------------------+----------+-----------------+
| Completed essay questions submitted to |          |                 |
| my office.                             |          |                 |
+----------------------------------------+----------+-----------------+
| Applications filed with both U.S.      |          |                 |
| Senators in Colorado (using THEIR      |          |                 |
| application forms).                    |          |                 |
+----------------------------------------+----------+-----------------+
| Request a Pre-candidate questionnaire  |          |                 |
| from each service academy to which you |          |                 |
| are considering applying (to be        |          |                 |
| returned to each academy).             |          |                 |
+----------------------------------------+----------+-----------------+
| School recommendation form completed   |          |                 |
| by your Principal or Guidance          |          |                 |
| Counselor and returned to my           |          |                 |
| Westminster office. Your Counselor     |          |                 |
| should include your official           |          |                 |
| transcript and test scores (if         |          |                 |
| convenient) with this form.            |          |                 |
+----------------------------------------+----------+-----------------+
| Two personal recommendation letters    |          |                 |
| from people who know you well should   |          |                 |
| be sent to my Westminster office.      |          |                 |
+----------------------------------------+----------+-----------------+
| SAT or ACT scores directed to my       |          |                 |
| Lakewood office.                       |          |                 |
+----------------------------------------+----------+-----------------+

For additional information or to check on the status of your file in my
office, please call my Service Academies staffer, Bill Holen at (303)
274-7944.

Page 8