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OMB 0703-0036

ICR 201610-0703-003 · OMB 0703-0036 · Object 69117201.

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application/vnd.openxmlformats-officedocument.presentationml.presentation
OMB 0703-0036
Windows User
Impress
2016-10-24
2026-08-01
failed_conversion

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OMB: 0703-0036
EXP: XX XXXX

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Privacy Act Statement
FOR OFFICIAL USE ONLY – PRIVACY ACT SENSITIVE: Any misuse or unauthorized disclosure of this information may
result in both criminal and civil penalties.
PRIVACY ACT STATEMENT:
Authority: 10 U.S.C. 5013, Secretary of the Navy; 10 U.S.C. 6954, Midshipmen: number; 10 U.S.C. 6956, Midshipmen:
Nominations and Selection to fill Vacancies; 10 U.S.C. 6957, Selection of Persons form Foreign Countries; 10 U.S.C. 6958,
Midshipmen: Qualifications for Admissions; 10 U.S.C. 6962, Midshipmen: Discharge for Unsatisfactory Conduct or Inaptitude; 10
U.S.C. 6958, Midshipmen: Discharge for Deficiency; E.O. 9397 (SSN), as amended; DoDI 1322.22, Service Academies; and
N01531-1.
Purpose: Applicant files contain information used for personal information verification and to evaluate/determine competitive
standing and eligibility for appointment to the Naval Academy. Midshipmen records consist of academic, military, and physical
records used to track each students progress in the Naval Academy program.
Routine Use: Information will only be collected and accessed by the United States Naval Academy for the purpose of admissions
and enrollment. Additionally, records may specifically be disclosed outside the DoD as a routine use pursuant to 5 U.S.C. 522a(b)(3)
as follows: 1.) to Congressional staffers for the purpose of reviewing applicants for status, nomination, and admission to the Naval
Academy; 2.) to parents and legal guardians of midshipmen for academic, performance, disciplinary, health, and/or welfare issues;
3.) to the United States Naval Academy Sponsor Program for the purpose of assigning Midshipmen with a sponsor; 4.) to the United
States Naval Institute for the purpose of relaying information about benefits; 5.) to the Naval Academy Athletic Association for the
purpose of promoting and funding the Naval Academy Intercollegiate Athletic Program; 6.) to the United States Naval Academy
Foundation for the purpose of sponsoring midshipmen candidates; and 7.) to the United States Naval Academy Alumni Association
for the purpose of supporting the Naval Academy mission.
Disclosure: Voluntary; however, failure to provide the required information may result in a delay or inability to process the
applicant’s application or allow for the continued enrollment of a Midshipman at the Naval Academy.

Privacy Act Statement

OMB Symbol

OMB Symbol

Agency Disclosure Notice
AGENCY DISCLOSURE NOTICE: The public reporting burden for this collection of information is estimated to average 1.35 hours,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing the burden, to the Department of Defense, Washington Headquarters Services, Executive Services
Directorate, Directives Division, 4800 Mark Center Drive, East Tower, Suite 02G09, Alexandria, VA 22350-3100 (OMB (0703-0036).
Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply
with a collection of information if it does not display a current valid OMB control number.
PLEASE DO NOT RETURN YOUR RESPONSE TO THE ABOVE ADDRESS.
Responses should be sent to: United States Naval Academy, Office of Admissions, 52 King George St., Annapolis, MD. 21402

Agency Disclosure Notice

1531/34 USNA Preliminary
Application
OMB Symbol
Privacy Act Statement

1531/34 USNA Preliminary
Application

1531/34 USNA Preliminary
Application

1531/34 USNA Preliminary
Application

Agency Disclosure Notice

Candidate Log In Page
OMB Symbol

Privacy Act Statement
Agency Disclosure Notice

Candidate Information System Page
OMB Symbol
Privacy Act Statement

Candidate Information System Page

Agency Disclosure Notice

Candidate Information System
Candidate Update Module
OMB Symbol
Privacy Act Statement

Agency Disclosure Notice

Personal Data Record
Personal Information

Personal Data Record
Schools Attended

Personal Data Record
Prior Service

1110/12 Personal Data Record
Police Record/School Probations

1110/12 Personal Data Record
Police Record/School Probations

1110/12 Personal Data Record
Father/Stepfather Information

1110/12 Personal Data Record
Father/Stepfather Information

1110/12 Personal Data Record
Mother/Stepmother Information

1110/12 Personal Data Record
Mother/Stepmother Information

1110/12 Personal Data Record
Sibling Information

1110/12 Personal Data Record
Current Studies

1110/12 Personal Data Record
Current Studies

1110/12 Personal Data Record
Academic Interest

1110/12 Personal Data Record
Language Skills

1110/12 Personal Data Record
Additional Information

1110/12 Personal Data Record
Additional Information

1110/12 Personal Data Record
Personal Statement

1110/12 Personal Data Record
Summary/Submission

1110/12 Personal Data Record
Summary/Submission

1110/12 Personal Data Record
Summary/Submission

1110/12 Personal Data Record
Summary/Submission

1110/12 Personal Data Record
Summary/Submission

1110/91 Candidate Fitness
Assessment

1110/91 Candidate Fitness
Assessment

1110/91 Candidate Fitness
Assessment
Privacy Act Statement

Agency Disclosure Notice

OMB Symbol

1110/11 Candidate Activities Record

1110/11 Candidate Activities Record

1110/11 Candidate Activities Record

1110/11 Candidate Activities Record

1110/11 Candidate Activities Record

1110/11 Candidate Activities Record

1110/11 Candidate Activities Record
Verification Email

1110/11 Candidate Activities Record
Verification
OMB Symbol
Privacy Act Statement

1110/11 Candidate Activities Record
Verification

Agency Disclosure Notice

English Recommendation

English Recommendation

English Recommendation
OMB Symbol
Privacy Act Statement

English Recommendation

Agency Disclosure Notice

Math Recommendation

Math Recommendation

Math Recommendation
OMB Symbol
Privacy Act Statement

Math Recommendation

Agency Disclosure Notice

1110/15 Candidate Academic
Information/Request for Transcript

1110/15 Candidate Academic
Information/Request for Transcript

1110/15 Candidate Academic
Information/Request for Transcript
OMB Symbol
Privacy Act Statement

1110/15 Candidate Academic
Information/Request for Transcript

Agency Disclosure Notice

1110/92 Request for Information
Application
OMB Symbol
Privacy Act Statement

1110/92 Request for Information
Application

Agency Disclosure Notice

Summer Seminar
OMB Symbol
Privacy Act Statement

Summer Seminar

Summer Seminar

Summer Seminar

Summer Seminar

Summer Seminar

Summer Seminar

Agency Disclosure Notice