Military Academy Nominations

Note: Fields marked with an * are required.

Authorization Form

Applicant Information
If you are currently in the military service, please provide the following information:
Academy Information
Select your preference (first to fourth) of academies — with first being your highest preference
In addition to my application with Congressman Rouzer, I am applying for a nomination from:
Education Background

Grade point average, scale, class rank and size must be included on your high school transcript.
Home schooled students – please mark class rank/size as 1 of 1 if official ranking is unavailable.

ACT/SAT scores reported on your official certified transcript are acceptable. Otherwise, please have your official scores sent directly from the testing service.

SAT code: 5554 ACT code: 7585

Extracurricular School and Community Activites
High School Sports
Non School Athletics
Leadership Roles
Extra-Curricular Activities
Additional Information
Parent/Guardian Information

Mother


Father


Please provide a photo, a student resume detailing your extra-curricular activities, and three (3) letters of recommendation supporting your nomination. One letter must be from your high school principal or school guidance counselor. Please submit the documents in a sealed envelope with the author’s signature written across the envelope flap.

CONGRESSMAN DAVID ROUZER
ATTN: LISA LITTLER
4001 US Hwy. 301 S.
Suite 106
FOUR OAKS, NC 27524
Human Validation