(This is intended as a guide. A separate letter must be sent to the Vice President and to each Senator and Representative to whom you apply.)

Date

Honorable (Name of Appropriate Authority)
House of Representatives OR United States Senate
Washington, DC 20515 OR Washington, DC 20510

OR

The Vice President
Dwight D. Eisenhower Executive Office Bldg
Washington, DC 20501

Dear (Mr./Mrs./Ms. Name) OR Dear (Senator/Representative Name) OR Mr. Vice President

I wish to attend the U.S. Air Force Academy and to serve in the United States Air Force. I request that I be considered as one of your nominees for the class that enters the Academy in June 20__.

My pertinent data is:

Name (print name exactly as it appears on the birth certificate, or if legally changed, attach a copy of the court order):

Social Security Number:

Permanent address (street, city, county, state, zip code):

Temporary address (if applicable):

Permanent phone number and area code:

Temporary phone number and area code (if applicable):

Name of father:

Name of mother:

Date and place of birth (spell out month):

Name and address of high school:

Date of graduation:

Approximate grade point average (GPA); rank in class; and PSAT, PACT/PLAN, ATP (SAT) and ACT, if you have taken these tests. Include verbal and math scores for the PSAT and ATP (SAT) tests; and English, math, reading and science reasoning for the ACT test and PACT/PLAN composite:

Extracurricular activities:

Reasons for wanting to enter the Air Force Academy:

Thank you for considering me as one of your nominees to the Air Force Academy.

Sincerely,

Signature