Date:

Director of Admissions

United States Military Academy

West Point, New York 10996-1797

Dear Sir:

I request a nomination under the ______________ category for the class entering the United States Military Academy in June/July 19___ and I submit the following data:

Name:

Address:

Telephone Number:

Date of Birth:

Social Security Number:

Names of Parents:

Military Rank of Parent:

Component and Branch of Service of Parent:

(A stepparent's military service is applicable for this category of nomination only if the applicant was adopted. If your parent is on active duty, you must furnish a statement of service signed by the unit adjutant. If your parent is retired or deceased, you must furnish a copy of retirement order or casualty report. Include a statement concerning the date, place and cause of death or the details of disability together with the claim number assigned to the veteran parent's case by the Veterans Administration, if appropriate.)

(Include a statement of the date and circumstances of the award of the Medal of Honor if applying under this category.)

(Please furnish the Official copy of supporting paperwork with your letter.)

Sincerely,

SIGNATURE