Required fields are followed by *.

Applicant Contact Information
U.S. Citizen? *
If you are currently in the military service, please provide the following information:
Academy Information
Please rank your preferred academies (first to fourth) – with first being your highest preference. If you have not applied to an academy, please choose N/A and do not rank. Only rank the academies to which you have applied.
In addition to my application with Congressman Rouzer, I am applying for a nomination from:
Parent/Guardian Information
Education Information
Grade point average, scale, class rank and size must be included on your high school transcript. Home schooled students – please mark class rank/size as 1 of 1 if official ranking is unavailable.

ACT/SAT scores reported on your official certified transcript are acceptable. Otherwise, please have your official scores sent directly from the testing service.

SAT code: 5554 ACT code: 7585
Extracurricular School and Community Activities
High School Sports:
Non School Athletics:

Leadership Roles:
Extra-curricular Activities:
Additional Information
Is it ok to use your name in a press release after receiving an appointment?
Please provide a photo, a student resume detailing your extra-curricular activities, and three (3) letters of recommendation supporting your nomination. One letter must be from your high school principal or school guidance counselor. Please submit the documents in a sealed envelope with the author’s signature written across the envelope flap.

CONGRESSMAN DAVID ROUZER
ATTN: LISA LITTLER
4001 US Hwy. 301 S.
Suite 106
Four Oaks, NC 27524