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Military Academy Nominations Form

Required fields are followed by *.

Applicant Contact Information
U.S. Citizen? *
If you are currently in the military service, please provide the following information:
Academy Information
Please rank your preferred academies (first to fourth) – with first being your highest preference. If you have not applied to an academy, please choose N/A and do not rank. Only rank the academies to which you have applied.
In addition to my application with Congressman Rouzer, I am applying for a nomination from:
Parent/Guardian Information
Education Information
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 Activities
High School Sports:
Non School Athletics:

Leadership Roles:
Extra-curricular Activities:
Additional Information
Is it ok to use your name in a press release after receiving an appointment?
Please provide a photo, a student resume detailing your extra-curricular activities, an official high school transcript, 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