UNITED STATES NAVAL ACADEMY
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PERSONAL INFORMATION

FIRST NAME  
LAST NAME  
ADDRESS  
 
CITY  
STATE  
ZIP  
HOME COUNTRY  
HOME PHONE  
CELL PHONE  
EMAIL  
DATE OF BIRTH  
SOCIAL SECURITY NUMBER  
ETHNIC BACKGROUND  
MOTHER'S FIRST NAME  
MOTHER'S LAST NAME  
MOTHER'S EMAIL  
MOTHER'S WORK PHONE  
MOTHER'S CELL  
MOTHER'S ALMA MATER  
MOTHER'S OCCUPATION  
FATHER'S FIRST NAME  
FATHER'S LAST NAME  
FATHER'S EMAIL  
FATHER'S WORK PHONE  
FATHER'S CELL  
FATHER'S ALMA MATER  
FATHER'S OCCUPATION  
LIVES WITH  
SIBLINGS  
LIST YOUR TOP 4 SCHOOLS  
IF YOU HAVE A NOMINATION, STATE YOUR CANDIDATE NO  
IS YOUR FATHER OR MOTHER ON ACTIVE MILITARY DUTY OR RETIRED WITH 20 YEARS OF ACTIVE SERVICE?  
DO YOU WEAR GLASSES OR CONTACT LENSES?  
IF YES, INDICATE TO THE BEST OF YOUR KNOWLEDGE YOUR UNCORRECTED VISUAL EXAMINATION READINGS: LEFT  
RIGHT  
IS YOUR VISION 20/20 WITH CONTACTS OR GLASSES? LEFT  
RIGHT  
ARE YOU COLOR BLIND?  
DO YOU HAVE ASTHMA?  
NON-ATHLETIC EXTRA CURRICULAR ACTIVITIES  
DO YOU KNOW ANYONE WHO IS CURENTLY A MIDSHIPMAN, OR HAS GRADUATED FROM THE U.S. NAVAL ACADEMY? IF YES, PLEASE INDICATE NAME AND RELATIONSHIP TO YOU  

ACADEMIC INFORMATION

HIGH SCHOOL / PREP SCHOOL NAME  

GRADUATION YEAR  
HIGH SCHOOL / PREP SCHOOL ADDRESS  
 
HIGH SCHOOL / PREP SCHOOL CITY  
HIGH SCHOOL / PREP SCHOOL STATE  
ZIP  
HIGH SCHOOL / PREP SCHOOL PHONE  
CLASS RANK/CLASS SIZE  
GPA/OUT OF  
PSAT VERBAL  
PSAT MATH  
PSAT DATE TAKEN  
ACT MATH  
ACT SCIENCE  
ACT ENGLISH  
ACT READING  
ACT COMPOSITE  
ACT DATE TAKEN  
SAT CRITICAL READING  
SAT WRITING  
SAT MATH  
SAT TOTAL  
SAT DATE TAKEN  
INTENDED MAJOR  
UPON GRADUATION, PLEASE SELECT THE COURSES YOU EXPECT TO HAVE COMPLETED (HOLD DOWN CTRL AND CLICK ON THE COURSES WITH YOUR MOUSE)  

ATHLETIC INFORMATION

HIGH SCHOOL / PREP SCHOOL COACH'S FIRST NAME  
HIGH SCHOOL / PREP SCHOOL COACH'S LAST NAME  
HIGH SCHOOL / PREP SCHOOL COACH'S EMAIL  
HIGH SCHOOL / PREP SCHOOL COACH'S CELL PHONE  
HIGH SCHOOL / PREP SCHOOL COACH'S WORK PHONE  
POSITION  
40 YARD DASH TIME  
HEIGHT  
WEIGHT  
JERSEY NO  
ATHLETIC HONORS  
OTHER SPORTS PLAYED (LIST HONORS AND LETTERS EARNED)  
GUIDANCE COUNSELOR FIRST NAME  
GUIDANCE COUNSELOR LAST NAME  
GUIDANCE COUNSELOR EMAIL  
GUIDANCE COUNSELOR WORK PHONE  
 

CLUB TEAM

CLUB TEAM NAME  
CLUB COACH'S FIRST NAME  
CLUB COACH'S LAST NAME  
CLUB COACH'S EMAIL  
CLUB COACH'S CELL PHONE  
 

To select multiple options, hold the 'Ctrl' key for PCs, or the 'Command' key for MACs.

2013 FALL TOURNAMENTS ATTENDING  

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