USCG Academy Application and Supplemental Forms

USCG Academy Application and Supplemental Forms

1625-0004 USCGA Application and Supplemental Forms 4

USCG Academy Application and Supplemental Forms

OMB: 1625-0004

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Welcome to the United States Coast Guard Academy Class of 2017 Application!
USCGA applications are not part of the ApplyYourself (AY) network and therefore require
you to create a unique username and password. Even if you already have an AY account
that you've used to apply to another institution, you'll need to create a new one using the
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Program, you can and should use that account to apply to the Class of 2017.

Please input your login
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submit an application once, so updates will need to be provided to the Admissions Office
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that you have read and understand our Privacy Act Statement. All information submitted to
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USCGA, including your personal statements, is protected under the Privacy Act.
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
or AIM Program; (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
USCGA or AIM Program selection process and tendering appointments to the same; (4)
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the information is not provided. Submissions of Evaluators will not be disclosed to the
applicant without Evaluator consent. Release to any other individual/entity is only as
required by law.

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OMB No. 1625-0004 (Expires: mm/dd/yyyy): 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 240 minutes. You may submit comments concerning the accuracy of this estimate
or any suggestions for reducing the burden to [email protected].

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United States Coast Guard Academy | Testchris1 Testmcmunn1

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Main

Welcome, Testchris1! Your application is in progress.

Details

USCGA 2017 Application
Applicant Information
Family Information
Educational Information
Extracurricular Information
Additional Information
Personal Statements

Recommendations
Downloadable Forms
Check Your Application

Logout

Testchris1 Testmcmunn1
User Name: testchris1

Please read the Applicant Handbook, in the "Downloadable
Forms" section, before beginning your application.
Thank you for your interest in the United States Coast Guard
Academy's Class of 2017. This application must be completed
online and submitted electronically. You do not have to complete
your application in one sitting - you may save your progress and
return to work on your application until it is ready to submit. You
can quickly switch between sections of the application by using
the navigational links located on the left side of the screen.
If possible, consider completing the "Recommendations" section
first to allow those individuals to begin working on your letters of
recommendation while you are working on your application.
Once you have completed your application, use the "Submit"
button located at the top of the page to begin the process of
electronically sending your application to our office.
Please note that you can only submit your application once
and, once submitted, you will not be able to make changes
to your application using the online system; however, you
may submit corrections via e-mail to
[email protected].

USCGA 2017 Application
Submission Status:
Not Submitted
Last Date Accessed:
8/16/2012 5:38:31 PM EST

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Navigation Overview
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User License Agreement

Your online application, personal statements, and all
supplemental material must be submitted by February 1, 2013.

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Main

USCGA 2017 Application
Applicant Information
Family Information
Sibling Information
Educational Information
Extracurricular Information
Additional Information
Personal Statements

Logout

Applicant Information
Questions marked with an asterisk (*) are required and must be answered.

Name & Social Security Number
Legal First Name*
Legal Middle Name
Legal Last Name*

Recommendations
Downloadable Forms
Check Your Application

Suffix

Select One 

Social Security Number*
###-##-####

Mailing Address
Mailing Address*
City*
State
Country*

Select One

Required if living in the U.S., U.S. Territories, or Armed Forces Regions.
Select One



Zip or Postal Code*
#####

Telephone Numbers & Email
Primary Phone Number
(###) ###-####; We recommend providing your home number

Alternate Phone Number
(###) ###-####; We recommend providing your cellular number

International Phone Number
Email Address*

[email protected]
Please ensure you provide an address that you will regularly maintain and
frequently check since we will send official correspondence via email
throughout the application process.

Personal Information
Height*
Inches

Weight*
Pounds

Date of Birth*
mm/dd/yyyy
You must be 17-22 years old on July 1, 2013 to apply for the Class of
2017.

Country of Birth*

Select One



City of Birth*
State of Birth

Select One



Required if born in the U.S.

Gender*

Select One 

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Marital/Dependency Status*
Citizenship*

Other Country of Citizenship

Are you fluent in another
language?*

Page 2 of 3



Select One

Select One

You must be a U.S. citizen to apply for the Class of 2017.
If you hold dual citizenship, please choose the other country below.


Select One

 Yes 




 No



If you are fluent (you can read, speak, and write) in a language other than
English, please enter the other language(s) below.

Other Language(s)

Are you of Hispanic or Latino ethnicity or heritage?*
Select One



Regardless of how you responded to the previous question, please select all races that best describe
you.

 African-American or Black (including Africa and the Caribbean)




 Asian (including Indian subcontinent and the Philippines)




 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 Academy
Introduction Mission Program?*

 Yes 




 No



The Academy Introduction Mission (AIM) Program is a one-week program
that students may attend the summer before their senior year of high
school.

Please select any other Admissions programs you have participated in.

 Academy Experience Program




 Admissions Briefing and Campus Tour




 Cadet for a Day




 Eclipse Week




 Genesis Invitational




 Guardian Challenge




 Open House




 Students Of All Races (SOAR) Program




 Science, Technology, Engineering Program (STEP)




Are you applying for Early Action consideration?*

 Yes 




 No



The deadline to submit all required application items for Early Action Group
One is October 15, 2012; the deadline for Early Action Group Two is
November 15, 2012.

Have you previously applied to USCGA?*

 Yes 




 No



If yes, please list the last year that you applied.

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yyyy

Have you ever been detained, arrested, summoned into court or participated in a diversion or probation
program?*

 Yes 




 No



If yes, please briefly explain.




Characters left in your response 120

Do you have any tattoos, brandings, or body piercings?*

 Yes 




 No



If yes, please briefly describe.




Characters left in your response 120

Military Information
Are you currently or have you previously been an active duty or reserve member of the U.S. military?*

 Yes 




 No



If yes, which branch of service?

Select One

Highest Rank Held

Select One 



Have you previously applied to another federal service academy or ROTC program?*

 Yes 




 No



Have you previously attended another federal service academy or ROTC program?*

 Yes 




 No




Application Home

Technical Support

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USCGA 2017 Application
Applicant Information
Family Information
Educational Information
Extracurricular Information
Additional Information
Personal Statements

Family Information
Questions marked with an asterisk (*) are required and must be answered.

First Parent's Information
Are they living?*

Recommendations

First Parent's First Name

Downloadable Forms

First Parent's Last Name

Check Your Application

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 Yes 




 No




Work Phone
(###) ###-####

Home Phone
(###) ###-####

International Phone Number
Email Address
Occupation
Did this parent graduate from
college?*

 Yes 




 No




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

Select One



Is this parent a graduate of one of the federal service academies?*


Select One

Is this parent currently an active duty or reserve member of the U.S. military?*

 Yes 




 No



Was this parent ever an active duty or reserve member of the U.S. military?*

 Yes 




 No



If yes to either of the two previous questions, which branch of service?
Select One
Highest Rank Held



Select One 

First Parent's Address
Does this parent have a different mailing address than you?

 Yes 




 No



Mailing Address
City
State

Select One



Required if living in the U.S.

Country

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

Select One
Zip or Postal Code
#####

Second Parent's Information
Are they living?*

 Yes 




 No




Second Parent's First Name
Second Parent's Last Name
Work Phone
(###) ###-####

Home Phone
(###) ###-####

International Phone Number
Email Address
Occupation
Did this parent graduate from
college?*

 Yes 




 No




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



Select One

Is this parent a graduate of one of the federal service academies?*


Select One

Is this parent currently an active duty or reserve member of the U.S. military?*

 Yes 




 No



Was this parent ever an active duty or reserve member of the U.S. military?*

 Yes 




 No



If yes to either of the two previous questions, which branch of service?
Select One
Highest Rank Held



Select One 

Second Parent's Address
Does this parent have a different mailing address than you?

 Yes 




 No



Mailing Address
City
State



Select One
Required if living in the U.S.

Country

Select One



Zip or Postal Code
#####

Other Information

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Parent's Marital Status

Page 3 of 3

Select One 

If you answered other, please
explain
If not living with both/either parent
(s), with whom do you reside?

Sibling Information
Do you have any siblings?*

 Yes 




 No




Application Home

Technical Support

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USCGA 2017 Application
Applicant Information
Family Information
Sibling Information
Educational Information
Extracurricular Information
Additional Information
Personal Statements

Logout

Sibling Information
Questions marked with an asterisk (*) are required and must be answered.

Oldest Sibling
First Name
Last Name
Age

Recommendations
Downloadable Forms
Check Your Application

Colleges(s) attended (if any)
Is this sibling attending or a graduate of one of the federal service academies?


Select One

Is this sibling currently or were they previously an active duty or reserve member of the U.S. military?

 Yes 




 No



If yes to the previous question, which branch of service?
Select One
Highest Rank Held



Select One 

Sibling 2
First Name
Last Name
Age
Colleges(s) attended (if any)
Is this sibling attending or a graduate of one of the federal service academies?


Select One

Is this sibling currently or were they previously an active duty or reserve member of the U.S. military?

 Yes 




 No



If yes to the previous question, which branch of service?
Select One
Highest Rank Held



Select One 

Sibling 3
First Name
Last Name
Age
Colleges(s) attended (if any)
Is this sibling attending or a graduate of one of the federal service academies?
Select One



Is this sibling currently or were they previously an active duty or reserve member of the U.S. military?

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 Yes 




 No



If yes to the previous question, which branch of service?
Select One
Highest Rank Held

Application Home



Select One 

Technical Support

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Main

USCGA 2017 Application
Applicant Information
Family Information
Sibling Information
Educational Information
Extracurricular Information
Additional Information
Personal Statements

Logout

Educational Information
Questions marked with an asterisk (*) are required and must be answered.

Current High School
Type of School*

Select One 

CEEB Code*

Look up
If your home school program cannot be found using the “Look Up” function,
please enter 777771 for your CEEB code. If you are a GED recipient,
please enter 777774 for your CEEB code.

Recommendations
Downloadable Forms

School Name*

Check Your Application

School Address*
City*
State

Select One

Country*

Select One




Zip or Postal Code
#####

Telephone Number
(###) ###-####

Attended From*
mm/yyyy

Graduation Date*
mm/yyyy

Have you attended another high
school?*

 Yes 




 No




Previous High School
Type of School

Select One 

CEEB Code

Look up
If your home school program cannot be found using the “Look Up” function,
please enter 777771 for your CEEB code. If you are a GED recipient,
please enter 777774 for your CEEB code.

School Name
School Address
City
State



Select One

Country



Zip or Postal Code
#####

Telephone Number
(###) ###-####

Attended From
mm/yyyy

Attended To
mm/yyyy

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Colleges and Universities
College Code

Look up

College/University Name
City
State

Select One



Zip or Postal Code
#####

Attended From
mm/yyyy

Attended To
mm/yyyy

Current Coursework
Please list the courses you are currently taking or plan to take and complete prior to July 2013.
You may enter up to eight courses.
Course Name 1
Course Name 2
Course Name 3
Course Name 4
Course Name 5
Course Name 6
Course Name 7
Course Name 8

Academic Information
If appointed, you will be assigned an academic advisor within your intended major. What is your
intended major?*
Select One
Are you a member of the National
Honor Society?*



 Yes 




 No




Briefly list any academic honors you received while in high school or college. Additional academic
honors information may be provided in your optional personal statement.




Characters left in your response 120

Standardized Test Scores
If you have already taken either the SAT or ACT exam, self-reporting your highest combined
scores will expedite review of your application; however, these test scores are considered
unofficial. Official scores must still be submitted either directly from the ACT/College Board or
recorded on your high school transcript.
SAT Critical Reading Score
SAT Math Score

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SAT Writing Score
ACT English Score
ACT Math Score
ACT Writing Score

Will you or did you receive any special accommodations - such as extended or unlimited time - when
taking the SAT Reasoning or ACT exam?*

 Yes 




 No



If yes, please briefly explain




Characters left in your response 120

Application Home

Technical Support

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USCGA 2017 Application
Applicant Information
Family Information
Sibling Information
Educational Information
Extracurricular Information
Additional Information
Personal Statements

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Extracurricular Information
* Indicates a required field

Activity 1
Please list the six most meaningful activities that you have participated in during your time in
high school or college (in order of importance to you).
Activity*

Select One



If other, please explain
Recommendations

Grade Level Participated*

Downloadable Forms

9




 10





Check Your Application

 11




 12




 Post High School




Varsity Letter

9




 10




 11




 12




 Post High School





Team Captain

9




 10




 11




 12




 Post High School





Leadership Position

9




 10




 11




 12




 Post High School





Achievements
If offered, I plan to participate in
this activity at the Academy

 Yes 




 No




Coach/Advisor Name
Coach/Advisor Telephone
Number

(###) ###-####

Activity 2
Activity

Select One



If other, please explain
Grade Level Participated

9




 10





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 11
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 12


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 Post High School


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Varsity Letter

9


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
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
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
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 Post High School

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
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Team Captain

9




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



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
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

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
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

 Post High School





Leadership Position

9




 10




 11




 12




 Post High School





Achievements
If offered, I plan to participate in
this activity at the Academy

 Yes 




 No




Coach/Advisor Name
Coach/Advisor Telephone
Number

(###) ###-####

Activity 3
Activity

Select One



If other, please explain
Grade Level Participated

9

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


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Varsity Letter

9




 10

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 Post High School


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

Team Captain

9




 10


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
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
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
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




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 Post High School




Leadership Position

9




 10




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
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
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



 Post High School





Achievements
If offered, I plan to participate in
this activity at the Academy

 Yes 




 No




Coach/Advisor Name
Coach/Advisor Telephone
Number

(###) ###-####

Activity 4
Activity

Select One



If other, please explain
Grade Level Participated

9




 10




 11




 12




 Post High School





Varsity Letter

9




 10




 11




 12




 Post High School





Team Captain

9




 10




 11




 12




 Post High School





Leadership Position

9




 10




 11




 12




 Post High School





Achievements
If offered, I plan to participate in
this activity at the Academy

 Yes 




 No




Coach/Advisor Name
Coach/Advisor Telephone
Number

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(###) ###-####

Activity 5
Activity

Select One



If other, please explain
Grade Level Participated

9




 10




 11




 12




 Post High School





Varsity Letter

9




 10




 11




 12




 Post High School





Team Captain

9




 10




 11




 12




 Post High School





Leadership Position

9




 10




 11




 12




 Post High School





Achievements
If offered, I plan to participate in
this activity at the Academy

 Yes 




 No




Coach/Advisor Name
Coach/Advisor Telephone
Number

(###) ###-####

Activity 6
Activity

Select One



If other, please explain
Grade Level Participated

9




 10




 11




 12




 Post High School





Varsity Letter

9




 10




 11





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 12




 Post High School




Team Captain

9




 10




 11




 12




 Post High School





Leadership Position

9




 10




 11




 12




 Post High School





Achievements
If offered, I plan to participate in
this activity at the Academy

 Yes 




 No




Coach/Advisor Name
Coach/Advisor Telephone
Number

(###) ###-####

Work Experience
List up to two jobs you have held during the past three years.
Specific nature of work
Employer
Employed From
mm/yyyy

Employed To
mm/yyyy

Approximate number of hours
worked per week
Employer Telephone Number
(###) ###-####

Work Experience 2
Specific nature of work
Employer 2
Employed From
mm/yyyy

Employed To
mm/yyyy

Approximate number of hours
worked per week
Employer Telephone Number
(###) ###-####

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Sibling Information
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Additional Information
Personal Statements

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Additional Information
Questions marked with an asterisk (*) are required and must be answered.

USCGA Information
How did you first learn about the
Coast Guard Academy?*
Detailed Source

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



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Section 2
Section 3

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Personal Statements
Questions marked with an asterisk (*) are required and must be answered.
Any information submitted in your personal statements is protected to the extent allowed under the
Privacy Act. These statements will only be reviewed by Coast Guard Academy faculty and staff, during
our review of your record, to learn about your background and readiness to be successful at USCGA.
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 or AIM Program; (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 USCGA or AIM Program selection
process and tendering appointments to the same; (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 Evaluator consent. Release to any other individual/entity is only
as required by law.

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. (Limit 500 words on a
single page)
To upload a document in response to this question, please click the
'upload' button below. If your upload is successful, you will see a 'view
document' button and a 'delete' button appear next to the question.

Personal Statement #2*

The Coast Guard Academy's mission is to develop leaders of
character. Describe examples of your leadership experience from
the past three years in which you have significantly influenced
others, helped resolve disputes, or contributed to group efforts over
time. (Limit 250 words on a single page)
To upload a document in response to this question, please click the
'upload' button below. If your upload is successful, you will see a 'view
document' button and a 'delete' button appear next to the question.

Personal Statement #3*

Describe your experience facing or witnessing discrimination or
unfair treatment. Tell us how you responded, what you learned from
those experiences, and how you believe they prepared you to
contribute to the Coast Guard Academy community. (Limit 250
words on a single page)
To upload a document in response to this question, please click the
'upload' button below. If your upload is successful, you will see a 'view
document' button and a 'delete' button appear next to the question.

Personal Statement #4

Provide any additional information about yourself that you feel we
need to know and that you have not provided elsewhere in your
application. In addition to providing a personal statement, not to
exceed a single page, you may upload copies of supplemental
information that you would like added to your record. (Limit 2500KB
upload)

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ApplyYourself Webcenter

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To upload a document in response to this question, please click the
'upload' button below. If your upload is successful, you will see a 'view
document' button and a 'delete' button appear next to the question.

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USCGA 2017 Application
Applicant Information
Family Information
Sibling Information
Educational Information
Extracurricular Information
Additional Information
Personal Statements

Recommendations
Downloadable Forms
Check Your Application

You must identify and provide contact information for the
four individuals who will be providing the following required
application items before you may submit your application:
 Your guidance counselor, or an appropriate school official,
must submit an official high school transcript and school profile
along with a letter of recommendation.
 Your current English instructor, or your English instructor from
last year, must submit a letter of recommendation.
 Your current mathematics instructor, or your math instructor
from last year, must submit a letter of recommendation.
 A sports coach, physical education instructor, or active duty
military member must administer and submit results from your
Physical Fitness Examination. Provide this individual the PFE
Manual, available in the "Downloadable Forms" section, in
advance so they are prepared to administer your exam.
You may identify and provide contact information for two
individuals to submit optional letters of recommendation.
Any individual submitting a letter of recommendation for your
application must submit it electronically through the AY online
system to ensure it is added to your record.

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Additional Information
Recommendation requests
are valid for 180 days.



Recommendation providers
must have unique and valid email addresses.



High school transcripts and
school profiles are the only
required recommendation items
that may be submitted offline.



If you completed the PFE
while attending AIM 2012, you
may use those results by listing
"AIM Program" as the name of
your PFE Administrator and
entering "[email protected]"
as the e-mail address.



My Recommendations
A recommendation provider is an individual who will complete
and submit a recommendation form on your behalf.
To add your recommendation providers:
Select the "My Recommendations" button above.
Select the "Add" button to insert the name, e-mail address,
and type of recommendation for each of your providers.
 Once the requested information is saved, an e-mail message
will be sent to each recommendation provider with an access
code and instructions for uploading your recommendation.
 You can view the status of your recommendation requests
from your application homepage and send reminder messages
to providers or reassign recommendation requests.



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You must identify and provide contact information for the four individuals who will be
USCGA 2017 Application providing the following required application items before you may submit your application:
Applicant Information
Family Information
Sibling Information
Educational Information
Extracurricular Information
Additional Information
Personal Statements

Recommendations
Downloadable Forms
Check Your Application

Your guidance counselor, or an appropriate school official, must submit an official high school
transcript and school profile along with a letter of recommendation.
 Your current English instructor, or your English instructor from last year, must submit a letter of
recommendation.
 Your current mathematics instructor, or your math instructor from last year, must submit a letter of
recommendation.
 A sports coach, physical education instructor, or active duty military member must administer and
submit results from your Physical Fitness Examination. Provide this individual the PFE Manual,
available in the "Downloadable Forms" section, in advance so they are prepared for your exam.


If you completed the PFE while attending AIM 2012, you may use those results by listing "AIM
Program" as your PFE Administrator and using "[email protected]" as the e-mail address.
In addition, you may identify and provide contact information for up to two individuals to
submit optional letters of recommendation; these letters may come from any source.
Any individual submitting a letter of recommendation for your application must submit it electronically
through the AY online system to ensure it is added to your record. Your application will not be
considered complete, and therefore will not be reviewed, until all four of the required items
listed above are received via the AY online system.

My Recommendations
My Recommendations

Status

No Recommendation Providers have been entered yet. Click the button below to
identify one of your Recommendation Providers.

Please note that notification emails will indicate "United States Coast Guard
Academy" as the sender but will come from [email protected]. If they use
a spam-blocking tool, please ask them to add this email address to their list of
known/safe addresses.
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Please Complete the Following

USCGA 2017 Application

Recommender First Name*
Applicant Information
Family Information
Sibling Information
Educational Information
Extracurricular Information
Additional Information
Personal Statements

Recommendations

Recommender Last Name*
Phone:
(###) ###-#### for a U.S. number
Email Address*
Title:
How long have you known
this recommender?:
Relationship to you*

-- Select --



Downloadable Forms
Check Your Application
Do you wish to waive your right to examine this letter of recommendation?*

 Yes




 No




Under the Family Educational Rights and Privacy Act of 1974, students have access to their
education record, including letters of recommendation. However, students may waive their
right to see letters of evaluation, in which case the letters will be held in confidence.

* indicates a required field
If you would like to include a personal note in the notification email that is delivered, please use
the space below:

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McMunn, Chris
From: United States Coast Guard Academy [mailto:[email protected]]  
Sent: Tuesday, August 21, 2012 1:31 AM 
To:  
Subject: Testchris1 Testmcmunn1's Request for a Recommendation 
 
Dear , 
 
This student is in the process of applying to the United States Coast Guard Academy.  They 
have requested that you complete a short online evaluation form and provide a letter of 
recommendation for their application. 
 
The United States Coast Guard Academy only accepts letters of recommendation submitted 
electronically, so please upload your recommendation by following the link below.  The 
provided personal access code and initial password are required to access this student's 
record and all letters of recommendation must be submitted by November 15, 2012 for Early 
Action consideration or February 1, 2013 for Regular Admissions. 
 
Thank you for your time and assistance. 
 
Please note that Testchris1 Testmcmunn1 has waived his/her right to review this letter of 
Recommendation. 
 
Submit your letter of Recommendation at: 
https://rec.applyyourself.com/?CID=174&code=UMHGJCYXISB 
 
Personal Access Code:  UMHGJCYXISB 
Initial Password:   
 
Name of Applicant:  Testchris1 Testmcmunn1 
Department/Major:   
 
For security purposes, please keep your Personal Access Code and Password confidential and do 
not share them with the applicant. 
 
You will use the password from this email for your initial login.  Once you login, you will 
be required to change your password to something that you select for security reasons.  You 
will receive another email with your updated password.   Please do not send your 
Recommendation as an attachment in response to this notification message. 
 
Thank You, 
 
United States Coast Guard Academy 
 
This message was sent by Hobsons on behalf of United States Coast Guard Academy at the 
request of Testchris1 Testmcmunn1 ([email protected]) 
 
If you are unable to follow the link above, copy and paste the following web address into 
your browser: 
https://rec.applyyourself.com 
 
For technical support, please access 
http://rec.applyyourself.com/AYContactHelpDesk/TechSupport.asp?packageType=Recommendation&ca=
uscga&p=UMHGJCYXISB 
1

Online System

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This information is valid for 180
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The ApplyYourself Recommendation Center is for individuals who have been asked to
submit letters of recommendation by an applicant applying to an ApplyYourself Member
institution. Please input your login information in the space provided below to access the
institution's recommendation form. You will need to input the Personal Access Code and
Password listed in your notification email. The Personal Access Code is valid for 180 days
from the date of your notification email.



Your Personal Access Code can be found in your notification email. You must enter
the code exactly as it appears in the email.
Your Password can also be found in your notification email. However, you are
required to change your password upon your initial login for security reasons.

Please enter your information and click the Login button
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OAJDOSJZTVA

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Please use the fields below to change your password. Your password must be between 8
and 20 characters in length. You must choose at least one letter and at least one number.
Please use letters and numbers only and remember that the password is case sensitive.
To locate your current password, please refer to the invitation email you received.
Once you successfully change your password, you will receive an email with your updated
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Please use either the navigational buttons at the bottom or the navigational links on the
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Applicant Information
Name:
Testchris Testmcmunn
Email:
[email protected]
Institution:
United States Coast Guard Academy
Department/Major:
Government
more info

>>

OMB No. 1625-0004 (Expires: mm/dd/yyyy): 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 75 minutes. You may submit comments concerning the accuracy of this
estimate or any suggestions for reducing the burden to [email protected].
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Status

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Recommender Information
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Recommender Name*

Name:

Title*

Testchris Testmcmunn

Occupation*

Email:
[email protected]

Phone Number*

Institution:
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United States Coast Guard Academy

Email Address*
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Academic Information

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High School Information
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Personal Information
Academic Information
Letter of Recommendation

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School Name*

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School Address*

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Zip or Postal Code*

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Institution:
United States Coast Guard Academy

(###) ###-#### for a U.S. number

Department/Major:

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Month/Year of Graduation*

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mm/yyyy

Cumulative GPA*
GPA Scale (4.0, 100, etc.)*
Rank in Class
Number of Students in
Class*
If class rank is unavailable,
please indicate approximate
percentile (e.g. Top 10%)
Percentage of class
expected to attend a four
year college*

Please upload a copy of your school’s profile and this student's most recent transcript,
including any standardized test scores. If you are unable to upload electronic copies of
these documents, please still complete/submit this online recommendation and then
mail the school profile and student transcript to: Director of Admissions (tp), U.S. Coast
Guard Academy, Admissions Office, 31 Mohegan Avenue, New London, CT 06320
High School Transcript

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Letter of Recommendation

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Letter of Recommendation*

Please upload a letter of recommendation concerning this
student's aptitude to perform at the United States Coast
Guard Academy. Depending upon your relationship with
the student, please address their academic readiness to
be successful in a rigorous technical curriculum infused
with writing requirements and their demonstrated
leadership, respect and compassion towards others.
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Letter of Recommendation
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Applicant Information
Name:
Testchris Testmcmunn
Email:
[email protected]
Institution:
United States Coast Guard Academy
Department/Major:
Government
more info

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Physical Fitness Examination

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Physical Fitness Examination
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Inches

Weight*

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Exam Results
Applicant Information

Cadence Push-Ups*

Name:

Cadence Push Ups Score*

Testchris Testmcmunn

Sit-Ups*

Email:
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SitUps Score*

Institution:
United States Coast Guard Academy

1.5 Mile Run Time*
mm

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ss

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1.5 Mile Score*
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PFE Score*
Comments*

Please provide any comments you would like to share
about the conditions the PFE was administered under or
the applicant's overall physical fitness level and readiness
to be successful in a military training environment.
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Date of PFE*
mm/dd/yyyy

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File Typeapplication/pdf
File Titlehttps://app.applyyourself.com/AYApplicantLogin/ApplicantConnect
Authorcmcmunn
File Modified2012-08-29
File Created2012-08-27

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