Form CGA-14, CGA-14A, C CGA-14, CGA-14A, C Coast Guard Academy Forms

USCG Academy Application and Supplemental Forms

1625-0004 USCGA Application and Supplemental Forms

USCG Academy Application and Supplemental Forms

OMB: 1625-0004

Document [pdf]
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United States Coast Guard Academy - Application Account Menu

Page 1 of 2

USCGA Home

Application Menu
Getting Started
Create Your Account
Account Directions & Information

USCGA Standard Application
If you don't already have an ApplyWeb account, you'll need to create one using the "Create
Your Account" link above before you can access our application. This account is different than
the USCGA profile you may have previously created to schedule a campus visit or request
information from our website.
Privacy Act Statement: In accordance with 5 USC 552(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 information: a) As background information on
applicants for the selection process; b) To contact the applicant; c) The social security number
may be used as a unique identifier; d) To determine if there are existing USCG records on the
applicant; and e) In performance of the duties of officials and employees of the USCG, in
managing and contributing to the admissions process and appointment of USCGA Cadets; (4)
Disclosure of the information is voluntary, but the applicant will not be considered further if the
information is not provided. Submissions of Evaluators will not be disclosed to the applicant
without consent.
OMB No. 1625-0004 (Expires 12/31/2011): 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 30 minutes. You
may submit comments concerning the accuracy of this estimate or any suggestions for
reducing the burden to [email protected].

* Please print and read the Applicant Handbook prior to starting your application.
US Coast Guard Academy (Class of 2016) Application

Class of 2016 Supplemental Forms
Applicant Handbook (PDF)
High School Transcript Form (PDF)
College Transcript Form (PDF)
Physical Fitness Examination Manual (PDF)

Manage Your Account
Review Your Activity
Change Your Password
Forgot Your Password?
Forgot Your Login?

NOTE: You will need Adobe Acrobat Reader to view any PDF documents.
If you do not have Acrobat Reader, you may get it here.

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United States Coast Guard Academy - Standard Application

Page 1 of 3

USCGA Home

USCGA Standard Application
Page 1 of 6 - Personal Information

Personal Data
Social Security Number:
Legal First Name:

-

-

(xxx-xx-xxxx)

Just

Legal Middle Name:
Legal Last Name:
Suffix:

Testing
N/A 

Mailing Address
Mailing Address 1:
Mailing Address 2:
City:
State:



Other
(includes U.S. territories and Canadian provinces)

Country:

-- Select One --



Zip or Postal Code:
Primary Phone Number:
(please do not enter dashes, numbers only)
Alternate Phone Number:
(please do not enter dashes, numbers only)
International Phone Number:
(please do not enter dashes, numbers only)
Email Address:
We will occasionally send official correspondence only via email, so
please ensure you're providing us an address you will keep and
check at least once a week.

Additional Personal Information
Height:

inches

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United States Coast Guard Academy - Standard Application

Weight:

Page 2 of 3

pounds

Date of Birth:

/

/

(mm/dd/yyyy)

City of Birth:
County of Birth:
(required if born in the United States)
State of Birth:



Other
(required if born in the United States)

Country of Birth:



-- Select One --

Gender: 
 Male 




 Female



Marital/Dependency Status:
Citizenship:



-- Select One --- Select One --



If you hold dual citizenship, please choose the other country below.

Other Country of Citizenship:



-- Select One --

Are you fluent in another 
 Yes 




 No



language? If you are fluent (reading, speaking and writing) in a language other
than English, please enter the other language below.
Other Language(s):
Are you of Hispanic or Latino 
 Yes 




 No 



 Decline to answer



ethnicity or heritage?
Regardless of your answer to the
 African-American or Black (including Africa and the Caribbean)




previous question, please select
 Asian (including Indian subcontinent and the Philippines)




all of the races which best 
describe you. 
 Native American or Alaska Native (including all original peoples




of the Americas)

 Native Hawaiian or Pacific Islander (original peoples)




 White (including Middle Eastern)




 Decline to answer






Did you attend the AIM
Program?

Which of the following
 Academy Experience




Admissions programs have you
 Admissions Briefing and Campus Tour



participated in? 









































Cadet for a Day
Eclipse Week
Genesis Invitational
Guardian Challenge
Open House
SOAR Program
STEP Program

Have you previously applied to
the Coast Guard Academy?



Are you currently or have you
previously attended a federal
service academy?

Yes 

Which academy?

-- Select One --



Yes 

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Are you currently or have you
previously been a member of the
armed forces?

Select the branch:

-- Select One --

Highest rank held:

-- Select One -- 

Page 3 of 3



Have you ever been detained, 
 Yes 




 No



arrested, summoned into court or
participated in a diversion or
probation program?




If yes, please explain:

Do you have any tattoos, 
 Yes 




 No



brandings, or body piercings?




If yes, please describe:

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U.S. Coast Guard Academy · 31 Mohegan Avenue · New London CT 06320-8103
Admissions Hotline 800.883.USCG (8724)

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10/17/2011

United States Coast Guard Academy - Standard Application

Page 1 of 4

USCGA Home

USCGA Standard Application
Page 2 of 6 - Educational Information

High school you attended:
Type of School:

-- Select One -- 
Find High School

School Name:
CEEB/ACT Code:

Home schooled
H00001

School Address:
City:
State:



Other
(includes U.S. territories and Canadian provinces)

Country:



-- Select One --

Zip or Postal Code:
Telephone Number:
(please do not enter dashes, numbers only)
Attended From:

/

(mm/yyyy)

Graduation Date:

/

(mm/yyyy)

Upload Transcript:

Upload

File Attached: (none)

NOTE: Submitting an unofficial transcript now will expedite the review of your application, but you are
still required to have an official transcript sent from your high school.

Other secondary school you attended:
Type of School:

-- Select One -- 
Find Other Secondary School

School Name:
CEEB/ACT Code:

NEW LONDON HIGH SCHOOL
070530

School Address:

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United States Coast Guard Academy - Standard Application

Page 2 of 4

City:
State:



Other
(includes U.S. territories and Canadian provinces)

Country:



-- Select One --

Zip or Postal Code:
Telephone Number:
(please do not enter dashes, numbers only)
Attended From:

/

(mm/yyyy)

Attended To:

/

(mm/yyyy)

Upload Transcript:

Upload

File Attached: (none)

NOTE: Submitting an unofficial transcript now will expedite the review of your application, but you are
still required to have an official transcript sent from your high school.

Colleges and Universities
Please list all colleges and universities at which you have taken courses for credit. Use the search
button to find each school. You will have the option to enter up to two institutions.

Most Recent College or University

Find Most Recent College or University
College/University Name:
City:
State:



Alabama
(includes U.S. territories and Canadian provinces)



Country:
Attended From:

/

(mm/yyyy)

Attended To:

/

(mm/yyyy)

Upload Transcript:

Upload Transcript

File Attached: (none)

Remove this school
NOTE: Submitting unofficial college transcripts now will expedite the review of your application, but you
are still required to have official transcripts sent from each institution.

Current Coursework
Please list the courses you are currently taking or plan to complete during your senior year in high
school or at college. You can enter up to eight courses.

Course Name:
Course Name:
Course Name:

 +/




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United States Coast Guard Academy - Standard Application

Page 3 of 4

(Check box to add/remove another course)

Academic Honors
Are you a member of the
National Honor Society?




Briefly describe any additional
academic honors you have
received while in high school or
college.



Major Selection
If appointed, you will be assigned
an academic advisor within your
intended major. What is your
intended major?



-- Select One --



Application Term

Test Scores
NOTE: Submitting unofficial SAT or ACT scores now will expedite the review of your application, but you
are still required to have official SAT or ACT scores sent directly from your high school, the College
Board, or the American College Testing. You may use section results from different exams in order to
provide your highest combined SAT or ACT scores below.

SAT
SAT Math Score:
SAT Critical Reading Score:
SAT Writing Score:

ACT
ACT Math Score:
ACT English Score:
ACT Writing Score:
Will you or did you receive any 
 Yes 




 No 



 Maybe



special accommodations - such
as extended or unlimited time when taking the SAT Reasoning
or ACT exam?



What additional accommodations
did you receive?


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United States Coast Guard Academy - Standard Application

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USCGA Home

USCGA Standard Application
Page 3 of 6 - Family Information (Optional)

Mother's Information
Is she living?



Mother's First Name:
Mother's Last Name:
Work Phone:
(please do not enter dashes, numbers only)
Home Phone:
(please do not enter dashes, numbers only)
International Phone Number:
(please do not enter dashes, numbers only)
Email Address
Occupation:
If your mother is a graduate of
one of the federal service
academies, please select:
Did your mother graduate from
college?



-- Select One --



College(s) attended (if any):
Highest Education Level:

-- Select One --

If your mother was or is a
member of the armed forces,
select branch:

-- Select One --

Highest Rank Held:





-- Select One -- 

Mother's Home Address (if different from your mailing address)
Mailing Address 1:
Mailing Address 2:
City:
State:

Other



(includes U.S. territories and Canadian provinces)

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United States Coast Guard Academy - Standard Application

Country:

Page 2 of 3



-- Select One --

Zip or Postal Code:

Father's Information
Is he living?



Father's First Name:
Father's Last Name:
Work Phone:
(please do not enter dashes, numbers only)
Home Phone:
(please do not enter dashes, numbers only)
International Phone Number:
(please do not enter dashes, numbers only)
Email Address
Occupation:
If your father is a graduate of one
of the federal service academies,
please select:
Did your father graduate from
college?



-- Select One --



College(s) attended (if any):
Highest Education Level:

-- Select One --

If your father was or is a member
of the armed forces, select
branch:

-- Select One --

Highest Rank Held:





-- Select One -- 

Father's Home Address (if different from your mailing address)
Mailing Address 1:
Mailing Address 2:
City:
State:



Other
(includes U.S. territories and Canadian provinces)

Country:

-- Select One --



Zip or Postal Code:

Family Information
Parents' Marital Status:

-- Select One -- 

If parents' marital status is other,
please explain:

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United States Coast Guard Academy - Standard Application

Page 3 of 3

If not with both parents, with
whom do you reside?

Sibling Information
You can enter up to four siblings.
Last Name:
First Name:
Age:
If this sibling is attending or is a
graduate of one of the federal
service academies, please
select:



-- Select One --

College(s) attended (if any):
If this sibling was or is a member
of the armed forces, select
branch:
Highest Rank Held:



-- Select One --

-- Select One -- 
 Check here to add/remove another sibling





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U.S. Coast Guard Academy · 31 Mohegan Avenue · New London CT 06320-8103
Admissions Hotline 800.883.USCG (8724)

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10/17/2011

United States Coast Guard Academy - Standard Application

Page 1 of 2

USCGA Home

USCGA Standard Application
Page 4 of 6 - Sports, Extracurricular Activities, and Work Experience

Sports and Extracurricular Activities
Please list up to six extracurricular activities that you have participated in. Start with the activity
which you believe has been the most meaningful to you. Briefly list any major accomplishments in
the "Achievements" block and any special awards or honors.
Activity:

-- Select One --



If other, explain:
Grade level participated: 
 12 



 9 



 10 



 11 



 Post H.S.



Varsity Letter: 
 12 



 9 



 10 



 11 



 Post H.S.



Team Captain: 
 12 



 9 



 10 



 11 



 Post H.S.



Leadership Position: 
 12 



 9 



 10 



 11 



 Post H.S.



Achievements:
If offered, I plan to participate 
 Yes 



 No



in this activity at the Academy:
Coach/Advisor Name:
Coach/Advisor Telephone
Number: (please do not enter dashes, numbers only)

 Check here to add/remove another activity





Briefly describe activities, if
any, related to technology,
science, math or engineering:





Work Experience
List any job(s) you have held during the past three years. You can enter up to four jobs.
Specific nature of work:
Employer:

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United States Coast Guard Academy - Standard Application

Approximate dates of From
employment: (mm/yyyy)

/

To

Page 2 of 2

/

Approximate number of hours
spent per week:
Employer Telephone Number:
(please do not enter dashes, numbers only)

 Check here to add/remove another job





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U.S. Coast Guard Academy · 31 Mohegan Avenue · New London CT 06320-8103
Admissions Hotline 800.883.USCG (8724)

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10/17/2011

United States Coast Guard Academy - Standard Application

Page 1 of 2

USCGA Home

USCGA Standard Application
Page 5 of 6 - Personal Statements
Instructions: Please include your name and the essay number at the top of each personal
statement.

Personal Statement #1
Explain why you are interested in attending the Coast Guard Academy and what you expect to get
out of your four years as a Cadet. Articulate other goals you have established for yourself and
your efforts to accomplish them. Give at least one example that demonstrates your work ethic and
diligence.
This statement is required and should be no more than 500 words.

Upload Essay

File Attached: (none)

Personal Statement #2
The Coast Guard Academy's mission is to develop leaders of character. Describe leadership
experiences where you have significantly influenced others, helped resolve disputes, or
contributed to group efforts over time.
This statement is required and should be no more than 250 words.

Upload Essay

File Attached: (none)

Personal Statement #3
Describe your experiences facing or witnessing discrimination. Tell us how you responded, what
you learned from those experiences, and how they have prepared you to contribute to the Coast
Guard Academy community.
This statement is required and should be no more than 250 words.

Upload Essay

File Attached: (none)

Personal Statement #4
The Coast Guard Academy is seeking future Cadets who have challenged themselves in the
classroom, their communities, and through extracurricular activities. Describe the most significant
challenge you have faced and the steps you have taken to address this challenge. Include
whether you sought guidance from anyone in facing the challenge, the role that person played,
and what you learned from the experience.
This statement is required and should be no more than 250 words.

Upload Essay

File Attached: (none)

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United States Coast Guard Academy - Standard Application

Page 2 of 2

Personal Statement #5
Provide any additional information about yourself that you feel we need to know and that you have
not provided elsewhere in the application.
This statement is optional and should be no more than 250 words.

Upload Essay

File Attached: (none)

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Admissions Hotline 800.883.USCG (8724)

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10/17/2011

United States Coast Guard Academy - Standard Application

Page 1 of 2

USCGA Home

USCGA Standard Application
Page 6 of 6 - Instructor Evaluations, Physical Fitness Examination, Sign and Submit

Instructor Evaluations
Instructions:
You are required to obtain instructor evaluations from the following individuals:
• English Instructor
• Math Instructor
• Coach or P.E. Instructor
Public Law 93-380, Educational Amendments Act of 1974, grants students the right to have
access to letters of recommendation in their placement files. By selecting "Yes" in the "Waive
Access?" box you are waiving your right to view the evaluation.
Upon submission of your application, an email will be sent to each instructor inviting them to
complete an online evaluation form on your behalf. You will be notified when each instructor
submits their evaluation or if they decline your request to complete an evaluation.
Recommender First Name

Recommender Last Name

Instructor

Waive Access?

English Instructor 
Recommender First Name


Recommender Last Name

Recommender Email

Waive Access?

Instructor

Math Instructor 
Recommender First Name

Recommender Email


Recommender Last Name

Instructor

Coach or P.E. Instructor 

Recommender Email

Waive Access?



Physical Fitness Examination
Instructions:
Provide contact information for the individual who will be administering your Physical Fitness
Examination (PFE). This is normally done by the same person who is completing your Coach or
P.E. Instructor evaluation, but may also be a personal trainer or active duty military member.
Upon submission of your application, an email will be sent to your PFE administrator requesting
they complete an online PFE scoring form on your behalf. You must still make arrangements to
schedule your PFE with your administrator and follow all procedures outlined in the PFE Manual.

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United States Coast Guard Academy - Standard Application

Page 2 of 2

If you completed and passed the PFE during AIM 2011, and do not plan to retake it, please enter
"AIM" for the administrator's first and last name and "[email protected]" for the e-mail address.
PFE Administrator First Name

PFE Administrator Last Name

PFE Administrator Email

Waive Access?



Commanding Officer Recommendation
Instructions:
If you are currently a member of the armed forces, provide contact information for your
Commanding Officer (CO) or Officer-In-Charge (OINC).
Upon submission of your application, an email will be sent to your CO or OINC inviting them to
complete an online recommendation form on your behalf. You will be notified when they submit
their recommendation or if they decline your request to submit a recommendation.
Commanding Officer First Name Commanding Officer Last Name Commanding Officer Email

Commanding Officer Rank

Waive Access?



-- Select One -- 

Confirmation and Electronic Signature
I certify that all information provided on this application is complete and accurate and all personal
statements are my original work. I will update the Admissions Office if any of the information
submitted on this application changes prior to my enrollment at the Coast Guard Academy.
I understand that in addition to my application and personal statements, I must submit an official
high school transcript, official SAT Reasoning or ACT (with Writing Test) exam scores, three
instructor evaluations, and a Physical Fitness Examination score before my record will be
considered complete and eligible for review by the Cadet Candidate Evaluation Board.

 I Agree






Date

10

17

2011

(mm/dd/yyyy)

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U.S. Coast Guard Academy · 31 Mohegan Avenue · New London CT 06320-8103
Admissions Hotline 800.883.USCG (8724)

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10/17/2011

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)
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 postmarked, and returned to the Admissions Office along with your other forms, by February 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. 08-11)

OMB No. 1625-0004
Expires 12/31/2011

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 20 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.

McMunn, Chris
Subject:

USCGA Recommendation Request for Just Testing

Dear English, 
 
Just Testing has requested that you submit a recommendation for their admission to the United 
States Coast Guard Academy. 
 
This applicant has waived the right to view their recommendation. 
 
Please go to the following web address to login to the ApplyWeb system or to create a new 
account if you have never used the system before: 
 
http://www.applyweb.com/lor?token=? 
 
Any "collection of information" as defined in the Paperwork Reduction Act of 1995 (codified 
at 44 U.S.C. 3501 et seq) on this webpage has not been approved by the Director of the Office 
of Management and Budget (OMB) and does not display a valid control number assigned by the 
Director.  Therefore, no person shall be subject to any penalty for failing to comply with 
any such collection of information. 
 
Thank you for your assistance and please contact my staff at 860‐701‐6775 if you have any 
questions about the Academy. 
 
Sincerely, 
 
Chris McMunn '97 
Associate Director for Operations 
U.S. Coast Guard Academy Admissions 
 
P.S. Should you experience any technical difficulties or require assistance with your 
account, please follow this link to check the FAQ or to contact CollegeNET Support: 
https://www.applyweb.com/public/input?s=helprec&p=1&HELP_APP_CODE=uscgeval 

1

U.S. Coast Guard
Academy

College
Transcript

Director of Admissions (tp)
U.S. Coast Guard Academy
31 Mohegan Avenue
New London, CT 06320
800-883-8724 (phone)
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.

ONLY FOR APPLICANTS WITH COLLEGE EXPERIENCE
Please provide the information requested in Section 1. Provide this form to the Registrar of your college or university and
request that an official transcript be mailed to the U.S. Coast Guard Academy at the address above. If the Registrar can
release an official transcript to you in a sealed envelope, you may submit it along with your other supplemental forms.
To be considered, the transcript must be postmarked and returned to the Admissions Office by February 1st.
Please Note: If you have graduated high school and are currently attending college, you must provide a complete college
transcript from the fall semester of the year before entry. If you are currently in high school and taking college courses as
a supplement to your required curriculum, you may provide the college grades available at the time of application.
Section 1:
Name: _________________________________________________________

Last Four Digits of SSN: __________________

Street Address: _____________________________________________________________________________________________
City: __________________________________________

State: _____________

Zip Code: _________________________

Telephone: ____________________________________

Email: ___________________________________________________

I request that my official transcript from ___________________________________________________________________________
be mailed to the U.S. Coast Guard Academy, Director of Admissions (tp), 31 Mohegan Avenue, New London, CT 06320.
Applicant Signature: ______________________________________________________ Date: ___________________________

Section 2: The above student is applying to the U.S. Coast Guard Academy. Please attach an official transcript to this
form (or a copy of this form) and mail it to the address at the top of this form. Alternatively, you may provide the
transcript directly to the applicant in a sealed envelope. Please note that transcripts must be postmarked by February 1st
to be considered. Please direct questions to the Academy’s Admissions Operations Branch at (860) 701-6775. Thank you
for your time and assistance.

U.S. Dept. of Homeland Security, USCG, CGA Form (Rev. 08-11)

OMB No. 1625-0004
Expires 12/31/2011

Instructor Evaluation for the United States Coast Guard Academy

Page 1 of 3

USCGA Home

Instructor Evaluation
The applicant indicated below is applying to the United States Coast Guard Academy and has
requested that you complete an online evaluation form.
This completed form (and attachment) will be sent electronically to the USCGA Admissions Office.
If you need technical assistance to complete this form, please send an email to the ApplyWeb
Help Desk at [email protected].
This applicant has waived the right to view their recommendation.

Applicant Information
Applicant First Name

Just

Applicant Last Name

Testing

Applicant City

0

Applicant Zip/Postal Code

0

Applicant Phone

0

Applicant Email



Other

Applicant State

[email protected]

Applicant Major Civil Engineering

Evaluator Information
Coach/Instructor First Name

English

Coach/Instructor Last Name

Teacher

Coach/Instructor Title
Coach/Instructor Email

[email protected]

Coach/Instructor Phone (

)

Coach/Instructor Type English Instructor

 Yes 




 No



 Low 




 Average 



 High




https://www.applyweb.com/cgi-bin/rec?s=USCGEVAL&handoff_id=1862383

10/17/2011

Instructor Evaluation for the United States Coast Guard Academy

Did you stipulate confidentiality
as a condition for providing
information?

Page 2 of 3

Do you have low, average, or
high familiarity with this
applicant?

Rankings
Instructions: Please rate the applicant in comparison with others whom you have known at similar
stages in their lives.
Above
Below
Not
Top 1% Top 10% Average Average Average Observed
Commitment to learning and
personal growth





































Commitment to a healthy lifestyle





































Ability to think critically





































Communicates effectively face to
face





































Communicates effectively in
written work





































Takes advantage of opportunities
to reach full potential





































Accepts criticism and makes
improvements





































Adjusts to a demanding schedule
of activities without neglecting
primary duties





































Exerts maximum effort showing a
strong desire to achieve in every
field





































Sets high standards for own
performance in a variety of
pursuits





































Consistently respects others





































Takes action to include group
members who are struggling or
left out





































Gains respect from subordinates,
peers, and seniors





































Please upload a separate letter of recommendation. Based on your area of expertise, please
address how the applicant will perform in the following areas:
English Instructor
1. Perform in a rigorous curriculum infused with writing requirements
2. Demonstrate respect and compassion toward others.
Letter of Recommendation:

Upload

File Attached: (none)

Signature
I certify that all the information given on this recommendation is complete and accurate.

https://www.applyweb.com/cgi-bin/rec?s=USCGEVAL&handoff_id=1862383

10/17/2011

Instructor Evaluation for the United States Coast Guard Academy

Page 3 of 3

 * Signature of Recommender (check to sign)




Date

10

17

2011

(mm/dd/yyyy)

IMPORTANT: After clicking Submit, please wait until you see the 'Thank You!' page before you
exit the system. Your recommendation has not been submitted successfully until you see the
confirmation page.

Save

Save & Exit

Submit > >

U.S. Coast Guard Academy · 31 Mohegan Avenue · New London CT 06320-8103
Admissions Hotline 800.883.USCG (8724)

https://www.applyweb.com/cgi-bin/rec?s=USCGEVAL&handoff_id=1862383

10/17/2011

McMunn, Chris
Subject:

USCGA Recommendation Request for Just Testing

Dear Math, 
 
Just Testing has requested that you submit a recommendation for their admission to the United 
States Coast Guard Academy. 
 
This applicant has waived the right to view their recommendation. 
 
Please go to the following web address to login to the ApplyWeb system or to create a new 
account if you have never used the system before: 
 
http://www.applyweb.com/lor?token=? 
 
Any "collection of information" as defined in the Paperwork Reduction Act of 1995 (codified 
at 44 U.S.C. 3501 et seq) on this webpage has not been approved by the Director of the Office 
of Management and Budget (OMB) and does not display a valid control number assigned by the 
Director.  Therefore, no person shall be subject to any penalty for failing to comply with 
any such collection of information. 
 
Thank you for your assistance and please contact my staff at 860‐701‐6775 if you have any 
questions about the Academy. 
 
Sincerely, 
 
Chris McMunn '97 
Associate Director for Operations 
U.S. Coast Guard Academy Admissions 
 
P.S. Should you experience any technical difficulties or require assistance with your 
account, please follow this link to check the FAQ or to contact CollegeNET Support: 
https://www.applyweb.com/public/input?s=helprec&p=1&HELP_APP_CODE=uscgeval 

1

Instructor Evaluation for the United States Coast Guard Academy

Page 1 of 3

USCGA Home

Instructor Evaluation
The applicant indicated below is applying to the United States Coast Guard Academy and has
requested that you complete an online evaluation form.
This completed form (and attachment) will be sent electronically to the USCGA Admissions Office.
If you need technical assistance to complete this form, please send an email to the ApplyWeb
Help Desk at [email protected].
This applicant has waived the right to view their recommendation.

Applicant Information
Applicant First Name

Just

Applicant Last Name

Testing

Applicant City

0

Applicant Zip/Postal Code

0

Applicant Phone

0

Applicant Email



Other

Applicant State

[email protected]

Applicant Major Civil Engineering

Evaluator Information
Coach/Instructor First Name

Math

Coach/Instructor Last Name

Teacher

Coach/Instructor Title
Coach/Instructor Email

[email protected]

Coach/Instructor Phone (

)

Coach/Instructor Type Math Instructor

 Yes 




 No



 Low 




 Average 



 High




https://www.applyweb.com/cgi-bin/rec?s=USCGEVAL&handoff_id=1862381

10/17/2011

Instructor Evaluation for the United States Coast Guard Academy

Did you stipulate confidentiality
as a condition for providing
information?

Page 2 of 3

Do you have low, average, or
high familiarity with this
applicant?

Rankings
Instructions: Please rate the applicant in comparison with others whom you have known at similar
stages in their lives.
Above
Below
Not
Top 1% Top 10% Average Average Average Observed
Commitment to learning and
personal growth





































Commitment to a healthy lifestyle





































Ability to think critically





































Communicates effectively face to
face





































Communicates effectively in
written work





































Takes advantage of opportunities
to reach full potential





































Accepts criticism and makes
improvements





































Adjusts to a demanding schedule
of activities without neglecting
primary duties





































Exerts maximum effort showing a
strong desire to achieve in every
field





































Sets high standards for own
performance in a variety of
pursuits





































Consistently respects others





































Takes action to include group
members who are struggling or
left out





































Gains respect from subordinates,
peers, and seniors





































Please upload a separate letter of recommendation. Based on your area of expertise, please
address how the applicant will perform in the following areas:
Math Instructor
1. Perform in a rigorous technical curriculum
2. Demonstrate respect and compassion toward others
Letter of Recommendation:

Upload

File Attached: (none)

Signature
I certify that all the information given on this recommendation is complete and accurate.

https://www.applyweb.com/cgi-bin/rec?s=USCGEVAL&handoff_id=1862381

10/17/2011

Instructor Evaluation for the United States Coast Guard Academy

Page 3 of 3

 * Signature of Recommender (check to sign)




Date

10

17

2011

(mm/dd/yyyy)

IMPORTANT: After clicking Submit, please wait until you see the 'Thank You!' page before you
exit the system. Your recommendation has not been submitted successfully until you see the
confirmation page.

Save

Save & Exit

Submit > >

U.S. Coast Guard Academy · 31 Mohegan Avenue · New London CT 06320-8103
Admissions Hotline 800.883.USCG (8724)

https://www.applyweb.com/cgi-bin/rec?s=USCGEVAL&handoff_id=1862381

10/17/2011

McMunn, Chris
Subject:

USCGA Recommendation Request for Just Testing

Dear PE, 
 
Just Testing has requested that you submit a recommendation for their admission to the United 
States Coast Guard Academy. 
 
This applicant has waived the right to view their recommendation. 
 
Please go to the following web address to login to the ApplyWeb system or to create a new 
account if you have never used the system before: 
 
http://www.applyweb.com/lor?token=? 
 
Any "collection of information" as defined in the Paperwork Reduction Act of 1995 (codified 
at 44 U.S.C. 3501 et seq) on this webpage has not been approved by the Director of the Office 
of Management and Budget (OMB) and does not display a valid control number assigned by the 
Director.  Therefore, no person shall be subject to any penalty for failing to comply with 
any such collection of information. 
 
Thank you for your assistance and please contact my staff at 860‐701‐6775 if you have any 
questions about the Academy. 
 
Sincerely, 
 
Chris McMunn '97 
Associate Director for Operations 
U.S. Coast Guard Academy Admissions 
 
P.S. Should you experience any technical difficulties or require assistance with your 
account, please follow this link to check the FAQ or to contact CollegeNET Support: 
https://www.applyweb.com/public/input?s=helprec&p=1&HELP_APP_CODE=uscgeval 

1

Instructor Evaluation for the United States Coast Guard Academy

Page 1 of 3

USCGA Home

Instructor Evaluation
The applicant indicated below is applying to the United States Coast Guard Academy and has
requested that you complete an online evaluation form.
This completed form (and attachment) will be sent electronically to the USCGA Admissions Office.
If you need technical assistance to complete this form, please send an email to the ApplyWeb
Help Desk at [email protected].
This applicant has waived the right to view their recommendation.

Applicant Information
Applicant First Name

Just

Applicant Last Name

Testing

Applicant City

0

Applicant Zip/Postal Code

0

Applicant Phone

0

Applicant Email



Other

Applicant State

[email protected]

Applicant Major Civil Engineering

Evaluator Information
Coach/Instructor First Name

PE

Coach/Instructor Last Name

Teacher

Coach/Instructor Title
Coach/Instructor Email

[email protected]

Coach/Instructor Phone (

)

Coach/Instructor Type Coach or P.E. Instructor

 Yes 




 No



 Low 




 Average 



 High




https://www.applyweb.com/cgi-bin/rec?s=USCGEVAL&handoff_id=1862379

10/17/2011

Instructor Evaluation for the United States Coast Guard Academy

Did you stipulate confidentiality
as a condition for providing
information?

Page 2 of 3

Do you have low, average, or
high familiarity with this
applicant?

Rankings
Instructions: Please rate the applicant in comparison with others whom you have known at similar
stages in their lives.
Above
Below
Not
Top 1% Top 10% Average Average Average Observed
Commitment to learning and
personal growth





































Commitment to a healthy lifestyle





































Ability to think critically





































Communicates effectively face to
face





































Communicates effectively in
written work





































Takes advantage of opportunities
to reach full potential





































Accepts criticism and makes
improvements





































Adjusts to a demanding schedule
of activities without neglecting
primary duties





































Exerts maximum effort showing a
strong desire to achieve in every
field





































Sets high standards for own
performance in a variety of
pursuits





































Consistently respects others





































Takes action to include group
members who are struggling or
left out





































Gains respect from subordinates,
peers, and seniors





































Please upload a separate letter of recommendation. Based on your area of expertise, please
address how the applicant will perform in the following areas:
Coach or P.E. Instructor
1. Meet the rigorous physical demands of a military service academy
2. Demonstrate respect and compassion toward others
3. Compete in a NCAA Division III varsity sport.
Letter of Recommendation:

Upload

File Attached: (none)

Signature
I certify that all the information given on this recommendation is complete and accurate.

https://www.applyweb.com/cgi-bin/rec?s=USCGEVAL&handoff_id=1862379

10/17/2011

Instructor Evaluation for the United States Coast Guard Academy

Page 3 of 3

 * Signature of Recommender (check to sign)




Date

10

17

2011

(mm/dd/yyyy)

IMPORTANT: After clicking Submit, please wait until you see the 'Thank You!' page before you
exit the system. Your recommendation has not been submitted successfully until you see the
confirmation page.

Save

Save & Exit

Submit > >

U.S. Coast Guard Academy · 31 Mohegan Avenue · New London CT 06320-8103
Admissions Hotline 800.883.USCG (8724)

https://www.applyweb.com/cgi-bin/rec?s=USCGEVAL&handoff_id=1862379

10/17/2011

McMunn, Chris
Subject:

USCGA PFE Request for Just Testing

Dear PFE, 
 
Just Testing has requested that you administer their Physical Fitness Examination (PFE) for 
admission to the United States Coast Guard Academy. 
 
Please go to the following web address to login to the ApplyWeb system or to create a new 
account if you have never used the system before: 
 
http://www.applyweb.com/lor?token=? 
 
Any "collection of information" as defined in the Paperwork Reduction Act of 1995 (codified 
at 44 U.S.C. 3501 et seq) on this webpage has not been approved by the Director of the Office 
of Management and Budget (OMB) and does not display a valid control number assigned by the 
Director.  Therefore, no person shall be subject to any penalty for failing to comply with 
any such collection of information. 
 
Just should be providing you our PFE Instruction Manual and a practice scoring form, but a 
copy is attached for your reference.  Thank you for your assistance and please contact my 
staff at 860‐701‐6776 if you have any questions about administering the PFE or reporting the 
results to the Academy. 
 
Sincerely, 
 
Chris McMunn '97 
Associate Director for Operations 
U.S. Coast Guard Academy Admissions 
 
P.S. Should you experience any technical difficulties or require assistance with your 
account, please follow this link to check the FAQ or to contact CollegeNET Support: 
https://www.applyweb.com/public/input?s=helprec&p=1&HELP_APP_CODE=USCGPFE 
 

1

Physical Fitness Examination (PFE) Scoring Form for the United States Coast Guard Aca... Page 1 of 2

USCGA Home

Physical Fitness Examination (PFE) Scoring
Form
The student below 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 questions below. Raw score is converted to points by
consulting the scoring table within the PFE Instruction Manual. Please direct questions to the
Academy's Admissions Operations Branch at (860) 701-6776. Thank you for your time and
assistance.
This completed scoring form will be sent electronically to the USCGA Admissions Office.
If you need technical assistance to complete this form, please send an email to the ApplyWeb
Help Desk at [email protected].
This applicant has waived the right to view their recommendation.

Applicant Information
Applicant First Name

Just

Applicant Last Name

Testing

Applicant City
Applicant State

0
Other

Applicant Zip/Postal Code

0

Applicant Phone

0

Applicant Email



[email protected]

Applicant Major Civil Engineering

Coach/Instructor Information
Coach/Instructor First Name

PFE

Coach/Instructor Last Name

Teacher

Coach/Instructor Title
Coach/Instructor Email

[email protected]

https://www.applyweb.com/cgi-bin/rec?s=USCGPFE&handoff_id=1862384

10/17/2011

Physical Fitness Examination (PFE) Scoring Form for the United States Coast Guard Aca... Page 2 of 2

Coach/Instructor Phone (

)

Event

Raw Score

Points

1) Cadence Push-Ups

push-ups

2) Two Minute Sit-Ups

sit-ups

3) 1.5 Mile Run

min

sec
Total Points

Body Measurements
Height

inches

Weight

pounds

Signature
I certify that all the information given on this recommendation is complete and accurate.

 * Signature of Recommender (check to sign)




Date

10

17

2011

(mm/dd/yyyy)

IMPORTANT: After clicking Submit, please wait until you see the 'Thank You!' page before you
exit the system. Your recommendation has not been submitted successfully until you see the
confirmation page.

Save

Save & Exit

Submit > >

U.S. Coast Guard Academy · 31 Mohegan Avenue · New London CT 06320-8103
Admissions Hotline 800.883.USCG (8724)

https://www.applyweb.com/cgi-bin/rec?s=USCGPFE&handoff_id=1862384

10/17/2011


File Typeapplication/pdf
File Titlehttps://www.applyweb.com/apply/uscgacad/
Authorcmcmunn
File Modified2011-12-22
File Created2011-10-17

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