CGA-14D Physical Fitness Exam (PFE) Scoring Form

U.S. Coast Guard
Academy

Physical Fitness
Examination (PFE)
Scoring Form

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. Ask either a coach or physical education instructor to administer this
examination, providing him/her this form and a copy of the PFE Instruction Manual in advance. Ensure the examiner completes
Section 2 and signs the form in pen after you’ve completed all events. Confirm your raw scores/points before signing the form
yourself. 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, where physical fitness is essential to cadet performance.
If accepted to the Academy, the applicant will retake this examination shortly after Reporting-In Day and incoming cadets
who receive a failing score will be disenrolled, so accurate reporting is critical. Please administer the examination in accordance
with the PFE Instruction Manual (provided by the student) and then complete the table below in pen. Raw score is converted to points
by consulting the scoring table within the PFE Instruction Manual. Please direct questions to the Academy’s Admissions Processing
Branch at (860) 701-6778. Thank you for your time and assistance.

Event

Raw Score

1) CADENCE PUSH-UPS

Points

push-ups

2) TWO MINUTE SIT-UPS

sit-ups

3) 1.5 MILE RUN

min

sec

Total Points
Body Measurements
1) HEIGHT

inches

3) WRIST

inches

2) WEIGHT

pounds

Coach/Instructor Name: _____________________________________ Title: _________________________________________
Signature:

________________________________

Date: _________________

Telephone: _________________________

By signing this form, I certify that the raw scores/points above are accurate. In addition, I understand that all incoming cadets
must retake this evaluation shortly after Reporting-In Day and anyone failing to meet the passing standard will be disenrolled.
Applicant Signature: _______________________________________________
U.S. Dept. of Homeland Security, USCG, CGA-14D (Rev. 02-08)

Date: ________________________________
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 1 hour. 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.