<p> REQUEST FOR CONGRESSIONAL NOMINATION</p><p>Full Name:______(as it appears on your birth certificate) Your Address:______(include both permanent and mailing address and zip code) Telephone:______Cell Phone:______</p><p>E-Mail Address:______</p><p>Names, address & phone of parents ______</p><p>______</p><p>Parent’s Email: ______</p><p>Date of Birth:______Place of birth:______</p><p>Gender:______</p><p>Social Security Number:______</p><p>High School:______(name and address) Date of High School Graduation:______</p><p>Approximate Standing is ______in a class of ______</p><p>Special skills, training or certification, i.e., foreign language proficiency, pilot certified, etc.:______</p><p>Academy Preference (1-4):</p><p>Air Force______Army______</p><p>Merchant Marine______Navy______</p><p>Congressman Mike Thompson, 2300 County Center Drive, Suite A100, Santa Rosa CA 95403 Phone (707) 542-7182 Fax (707) 542-2745</p>