U.s. Service Academy Nomination Application - Congress Of The United States
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1
2
3CONGRESSWOMAN COLLEEN HANABUSA
ST
1
DISTRICT, HAWAII
422 CANNON HOUSE OFFICE BUILDING
WASHINGTON, DC 20515
TELEPHONE: 202-225-2726
Congress of the United States
FAX: 202-225-0688
House of Representatives
1132 BISHOP ST.
SUITE 1910
Washington, DC 20515-1101
HONOLULU, HI 96850
TELEPHONE: 808-541-2570
FAX: 808-533-0133
U.S. Service Academy Nomination Application
Please fill out, print, and sign this application form. This form and your complete application file must be
dropped off or postmarked as one packet to Congresswoman Hanabusa’s Honolulu Office by
10/31/2017.
Full Name: _______________________________________________________________
Date of Birth: ________________
MM/DD/YYYY
Social Security #:______-____-______
Gender: __Male __Female
Home Address: ___________________________________________________________
City: ______________________
State: HI
Zip Code: __________
Mailing Address: __________________________________________________________
City: ______________________
State: ____
Zip Code: __________
Telephone: _______________
Mobile: _______________
Email: __________________________________________________________________
U.S. Citizen: __Yes __No
If not, list your country of citizenship: _____________________________
Parent(s)/Guardian(s): _____________________________________________________
Name of High School: ______________________________________________________
High School Street Address: _________________________________________________
City: ______________________
State: ____
Zip Code: __________
GPA: _____
Class Size: _____
Rank: ____
Graduation Date: _________
Name of College/University: ________________________________________________
College/University Street Address: ___________________________________________
City: ______________________
State: ____
Zip Code: __________
SAT Scores
Math: _____ Writing: _____ Critical Reading: _____ Composite: _____
Request official score reports be sent to our office by using code 4432
ACT Scores
Math: _____ English: _____ Reading: _____ Science: _____ Composite: _____
Request official score reports be sent to our office by using code 7366
Office of Hawaii’s First Congressional District U.S. Service Academy Nomination Application
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