CGA-14A High School Transcript

U.S. Coast Guard
Academy

High
School
Transcript

Director of Admissions (tp)
U.S. Coast Guard Academy
31 Mohegan Avenue
New London, CT 06320
800-883-8724 (phone)
860-701-6700 (fax)
www.uscga.edu
[email protected]

Privacy Act Statement. In accordance with 5 USC 552a(e)(3), the following
information is provided to you when supplying personal information to the USCG.
(1) Authority which authorizes the solicitation of the information: 14 USC 182(a).
(2) The Principal Purpose for this information is to ensure that the applicant is
basically qualified to apply for the USCGA. (3) Routine uses which may be made of
the info: As background info on applicants for the selection process. To contact the
applicant. The SSN is a basic identifier. To determine if there are existing USCG
records on the individual. In performance of the duties of officials and employees of
the USCG, in managing and contributing to the admissions program and
appointment of Cadets. (4) Disclosure of the information is voluntary, but the
applicant will not be considered further if the information is not provided.
Submissions of the Evaluator will not be disclosed to the applicant without consent.

Please provide the information requested in Section 1. On the front of an envelope, print the following four lines of information:
(1) Your Name; (2) The last four digits of your SSN; (3) High School Transcript; and (4) U.S. Coast Guard Academy. Provide this
form and the envelope to your guidance counselor and request that your transcript and this form be returned to you in the sealed
envelope. This form must be returned to the Admissions Office, along with your other supplemental forms, by March 1st.
Section 1:
Name: _________________________________________________________

Last Four Digits of SSN: __________________

City: __________________________________________

State: _____________

Zip Code: _________________________

Telephone: ____________________________________

Email: ___________________________________________________

Section 2: The above student is applying to the U.S. Coast Guard Academy. Please complete this form and attach the following:
(1) An official transcript of grades through (at least) the end of the applicant’s junior year;
(2) A list of courses in progress, including classes scheduled for the applicant’s senior year;
(3) Any known SAT or ACT scores taken without accommodation(s);
(4) A school profile; and
(5) A separate letter of recommendation that discusses how well this student will: 1) Perform in a challenging academic
environment; and 2) Demonstrate respect and compassion toward others.
Please seal all materials and this form in the envelope provided by the applicant. Sign your name over the envelope seal to ensure
confidentiality and return it to the student. Thank you for your time and assistance.
Applicant Info:
Month/Year of Graduation:
Cumulative GPA:
Rank in Class:

_______________

Ranking Period (mm/yy) __________

to __________

_______________________

GPA Scale (4.0, 5.0 etc): ___________________________

__________________________

Number of Students: ______________________________

If rank is unavailable, indicate the approximate placement percentile (Top 10% etc):

__________________

High School Info:
Official Name of School:
ETS Code:
City:

_____________________________________________________________________

_____________________________________

_______________________________

Phone Number: __________________________

State: ______________ Zip Code: _____________________

Percentage of class expected to enter 4 year college: _________________ 2 year college: _________________
Type of School (Public, Private, etc.): _________ ___________________________________________________
Counselor Name: ______________________________________

Title: ___________________________________

Signature: ____________________________________________

Date: ___________________________________

U.S. Dept. of Homeland Security, USCG, CGA-14A (Rev. 02-08)

OMB No. 1625-0004

An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control
number. The Coast Guard estimates that the average burden for this form is 18 minutes. You may submit any comments concerning the accuracy of
this estimate or any suggestions for reducing the burden to: U.S. Coast Guard Academy, 31 Mohegan Avenue, New London, CT 06320, or Department
of Homeland Security Desk Officer, Office of Management and Budget, Office of Information and Regulatory Affairs, Washington, D.C. 20503.