<p>United States Service Academy Application for Nomination</p><p>Representative Fred Upton 157 S. Kalamazoo Mall, Suite 180 Kalamazoo, Michigan 49007 (269) 385-0039 www.upton.house.gov APPLICATION FOR NOMINATION</p><p>1. NAME: Click here to enter text. (last, first, middle) </p><p>2. DATE OF BIRTH: Click here to enter text. (year, month, day)</p><p>3. SOCIAL SECURITY NUMBER: Click here to enter text.</p><p>4. HOME ADDRESS: Click here to enter text. Click here to enter text. Click here to enter text. Click here to enter text.</p><p>5. COUNTY IN WHICH YOU RESIDE: Click here to enter text. YOUR HIGH SCHOOL: Click here to enter text.</p><p>6. HOME TELEPHONE NUMBER: Click here to enter text. CELLULAR TELEPHONE NUMBER: Click here to enter text. EMAIL: Click here to enter text. CONTACT NUMBER AT COLLEGE/PREP SCHOOL: Click here to enter text.</p><p>7. NAME OF PARENT(S) OR GUARDIAN(S): Click here to enter text.</p><p>8. ADDRESS, IF DIFFERENT THAN YOURS: Click here to enter text. Click here to enter text. Click here to enter text.</p><p>9. ARE YOU A CITIZEN OF THE UNITED STATES OF AMERICA? Choose an item.</p><p>10. HAVE YOU, OR ARE YOU EXPECTING TO APPLY FOR A NOMINATION THROUGH ANOTHER SOURCE? Choose an item.</p><p>IF YES, PLEASE STATE OTHER SOURCE: Click here to enter text.</p><p>11. PLEASE LIST, IN ORDER, YOUR ACADEMY PREFERENCE: Choose an item. ARMY Choose an item. NAVY Choose an item. AIR FORCE Choose an item. MERCHANT MARINE</p><p>NOTE: YOUR “PREFERENCE” MAY BE CHANGED AS LATE AS THE DAY OF YOUR PERSONAL INTERVIEW. Item 12: Proof of Residency Please provide proof of residency for the 6th Congressional District in Michigan, by attaching a copy of one of the following documents: - Valid Michigan drivers license - Property tax documents - Federal or Michigan Income tax documents</p><p>NOTE: FAILURE TO PROVIDE PROOF OF RESIDENCY WILL DISQUALIFY YOU FROM NOMINATION. Item 13: School Related Extracurricular Activities: Please list all school related extra-curricular activities in which you have participated.</p><p>Click here to enter text. Item 14: Outside Activities: Please list all activities in which you participated outside of school, such as civic work, church involvement, or any other activities not associated with school.</p><p>Click here to enter text. Item 15: Work Experience</p><p>Click here to enter text. Item 16: One Page Essay: Please write a ONE page essay in which you state your reasons for wanting to attend a United States Service Academy.</p>