Date:

The Honorable_____________

United States Senate *OR* House of Representatives

Washington, D.C. 20510-0001

Dear Senator *OR* Dear Mr./Ms.

I desire to attend the United States Military Academy and be commissioned in the U.S. Army. I respectfully request that I be considered as one of your nominees for the class entering West Point in June/July 19____.

The following data are furnished for your information:

Name:

Permanent Address:

Telephone Number:

Temporary Address and telephone number (if different from above):

Date of Birth:

High School:

Social Security Number:

Names of Parents:

I have/have not requested that an admissions file be initiated for me at the West Point Admissions Office.

Sincerely,

Signature