Request for Congressional Nomination

REQUEST FOR CONGRESSIONAL NOMINATION

Full Name:______(as it appears on your birth certificate) Your Address:______(include both permanent and mailing address and zip code) Telephone:______Cell Phone:______

E-Mail Address:______

Names, address & phone of parents ______

______

Parent’s Email: ______

Date of Birth:______Place of birth:______

Gender:______

Social Security Number:______

High School:______(name and address) Date of High School Graduation:______

Approximate Standing is ______in a class of ______

Special skills, training or certification, i.e., foreign language proficiency, pilot certified, etc.:______

Academy Preference (1-4):

Air Force______Army______

Merchant Marine______Navy______

Congressman Mike Thompson, 2300 County Center Drive, Suite A100, Santa Rosa CA 95403 Phone (707) 542-7182 Fax (707) 542-2745