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United State Service Academies Nomination Recommendation Form

The following Letter of Recommendation form has to be completed by the candidate’s evaluator. The evaluators are required to give analysis and make comments that will be stated in the form which will assist in determining the nomination of the candidate as one of the nation’s service academies: U.S. Military Academy, U.S. Naval Academy, U.S. Air Force Academy or U.S. Merchant Marine Academy.

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UNITED STATES SERVICE ACADEMIES NOMINATION	 	
 	
LETTER of RECOMMENDATION FORM	 	
Thank you for agreeing to complete this recommendation form for the candidate who selected 
you. Your analysis and comments of this young person will help determine if this individual	 will 	
receive a congressional nomination for one of our nation's service academies: U.S. Military 
Academy, U.S. Naval Academy, U.S. Air Force Academy or U.S. Merchant Marine Academy. 
As you might expect, the process is selective to ensure that qualified an	d sincere candidates 	
receive nominations to the institutions that mold our future leaders. Your recommendation will 
be considered by my Academy Advisory Committee in assisting me to ensure we send 
Northwest Indiana’s best and brightest to be educated and t	rained to be America’s future leaders. 	 	
 
Your recommendation, or lack thereof, may determine whether or not an applicant is selec	ted. 	 	
 
Prior to completing this form, you are advised to discuss with the candidate his/her interest in the 
Academies. Your conversation will assist you in completing this form and will help the 
candidate to assess his/her interest in applying. I encourage	 you to comment whenever you desire 	
to clarify or extend your evaluation. Your information is a vital part of the application process; 
therefore, it is extremely important and sincerely appreciated.	 	
 
This recommendation may be mail	ed	 or fax	ed	 to my office.	 Please complete it as soon as 	
possible. 	 	
 
Mailing Address:	 	
Honorable Pete Visclosky	 	
7895 Broadway, Suite A	 	
Merrillville, Indiana 46410	 	
Phone (219) 795	-1844 or	 	
(888) 423	-7383	 	
Fax (219) 795	-1850	 	
 
Sincerely,	 	
Pete Visclosky	 	
Member of Congress

RECOMMENDATION	 FORM	 	
 	
 
Candidate Name: 	 	  	
 
  	
TO BE COMPLETED BY THE EVALUAT	OR:	 	
Name:	 ____	_______________________________	_______________	__	____________________	 	
Telephone:	 _________________	___________________________________________________	 	
School:	 _______________	_____________________________________	___________________	   	
Current Position:	 ____________________________________________	___________________	   	
Grade Level:	 _________________	_______________________________	_________	__________	 	
Subject Taught:	 _____________________________________________	__________________	_ 	
 
How well do you know the applicant?	 	
□	Ve	ry Well (more than one year):	 	  	
□	Fairly Well (more than one semester):	 	  	
□	Not Very W	ell (less than one semester):	 	  	
Do you feel comfortable being asked to evaluate the candidate?	 	 □	Yes	 □	No	 	
 
How strongly do you recommend this candidate for a service academy?	 	
On a scale of 1 (not recommended) to 5 (strongly recommended):	 __	__ 	  	
INSTRUCTIONS:	 	
Using the scale below, rate each statement on how it best describes the candidate in relation to 
other students. Enter only one response for each statement.	 	
5 = Top 5% 4 = Top 10% 3 = Top 25% 2 = Average 1 = Below Average N/A = Not Observed	 	
1. Gets along w	ith others. Shows concern for the welfare of others	.  	__	__ 	  	
2. Communicates effectively in face to face discussion.	 	 	 	__	__  	
3. Communicates effectively in written work.	 	 	 	 	___	_ 	
4. Exhibits leadership skills.	   	 	 	 	 	 	___	_ 	
5. Sets realistic goals. Exerts maximum effort to achieve h	is/her goals.	  	___	_ 	
6. Seeks academic challenges beyond that required by normal class work.	 ___	_ 	  	
7. Actively participates 	in extracurricular activities. 	  	 	 	__	__ 	
8. Accepts criticism and makes improvement from it.	 	 	 	___	_    	
9. Exercises care about his/her appearance.	  	 	 	 	___	_    	
10.	 Shows a strong motivation for a service academy / career.	  	 	____

Please comment below. We need your honest input. Describe personal circumstances (positive 
and negative) which may have impacted on this individual’s development (scholastic, personal, 
physical	, career). You may want to consider the following: family obligations, family 	
background, economic status, motivation, after school employment, etc. Teachers, if there is a 
significant disparity between the student's SAT/ACT scores and his/her classroom pe	rformance, 	
please comment in the space provided below.	 	
 
  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Signature:  	______________________________________________________________
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