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:
Temporary Address and telephone number (if different from above):
Date of Birth:
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.