Pre-Candidate Procedures

West Point Candidate Questionnaire
[Name here]

SSN / West Point ID:

********* / xxxxxxxxx

Date: 08/08/2016
Address:
City, State, Zip:
Phone / Cell:
E-Mail Address:
Date of Birth / Citizenship:
Race/Ethnicity:
Birth

1 Road Street
WEST POINT, NY 10996 - 1700
(555) 555-5555 /
[email protected]
XX/XX/199X /

US

Gender:

Congressional
State/District:
High School
Name/ETS Code:

Grad Year: Rank/Nbr In Class:

Standardized Tests
PSAT:
SAT:
ACT:

Verbal:
Verbal:

Math:
Math:

English: 4 Math: 4 Reading: 4 Sci/Rea: 4

Athletic Activities
Primary Sport:
Years:
Secondary Sport:
Other Sports:

Varsity Ltrs:

Team Cpt:

Spec Recog:

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Non-Athletic Activities

Military Service
Member of Armed Services?
Combat Veteran?
Release of Info Authorization
Parental Release?
Diagnosed w/ADD or ADHD?
Corrective eye surgery?
Release to Edu Testing Svc?
Remarks:
Other Colleges
Compete For ARMY ROTC Scholarship?
Colleges Applied To:
Majors at other schools:

USMA E-Form 21-27, 1 OCT 2006

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