Online Application (OA)

United States Coast Guard Academy Introduction Mission Program Application and Supplemental Forms

1625-0121_AIM Application_Registration

Online Application (OA)

OMB: 1625-0121

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Online Application Login

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Create Account

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Welcome to the United States Coast Guard Academy Application Portal!

User Login

Please input your login information below to open your application.
User Name

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 "Create Account"
tab (right side of this screen) before you can access our applications.
This new AY account allows you to save your progress on our
applications, so that you can return to work on your applications over
several sessions and transmit your information to us through a secure
server. If you previously created an AY account to apply to our AIM
Program, you can and should use that account to apply for direct entry to
the Academy; however, if you previously applied for direct entry to the
Academy, you must create a new account using the "Create Account"
tab in order to reapply for admission this year.

Password

login

Please carefully read all instructions that appear throughout our
applications. You can only submit an application once, so updates will
need to be provided to the Admissions Office via e-mail for inclusion in
your record. By accessing our applications, you are confirming that you
have read and understand our Privacy Act Statement. All information
submitted to USCGA, including your personal statements, is protected
under the Privacy Act.

Forgot your User Name or Password?

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 is used by the Department of Defense Medical Examination
Review Board 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 may 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.
USCGA Application: OMB No. 1625-0004 (Expires: 3/31/2019): 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].
AIM Application: OMB No. 1625-0121 (Expires: 2/28/2018): 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 180 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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Online Application Login

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Create An Application Account
Thank you for your interest in applying for admission to the Class of 2022. The application will open in August
2017 and close on January 15, 2018. Your first step is to create an application account which will allow you to
receive further communication from our Admissions Office and access the application during the time period
listed above. You may complete this step even before the application opens and then update your account
information later if it changes. Please provide as much information as possible, taking special notice of all
required fields denoted with an asterisk (*).
NOTE: If you previously created an application account in order to apply for the Academy Introduction Mission
(AIM) Program for Summer 2017, please do not create a new account to apply for the Class of 2022. You should
use your AIM application account to access the Class of 2022 application; however, if you have previously
applied for direct entry to the Academy, you must create a new account in order to reapply for admission this
year.

Basic Information
Full Name
First Name *
Middle Name
Last Name *
Gender *
Male
Female
Street Address 1 *
Street Address 2
Country *
Select One



City *
Zip/Postal Code *
#####
Phone *
Email Address *
Verify Email Address *

https://uscga.askadmissions.net/emtinterestpage.aspx?ip=classapplication

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Online Application Login

Birthdate *
Month



Day



Year

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

Login Information
Please create your user name and password in the space below. This information will be used to access your
online application.
User Name *
Password *
Passwords must be between 8-30 characters, contain at least 1 uppercase letter (A-Z), 1 lowercase letter (a-z), 1
number (0-9), and 1 of the following special characters: !@#$%^&*()_+|~-=\`{}[]:";<>?,./ Spaces are not
allowed.
Verify Password *
Submit Information

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Online Application Login

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Congratulations! Your information has been successfully submitted.
Shortly you will receive a confirmation message to the email address that you provided when creating your
account.
You may now access the online application using the user name and password you created.

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2/7/2017

EULA

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Terms Of Use

By clicking "I agree" you acknowledge that you have read and understand the terms and conditions. Your acknowledgement is
required for you to proceed.

I agree

Privacy Policy
Upon creating your account, all information that you provide and save will be immediately available to the institution.
I have read the above notice

Continue and Create

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My Application(s)
USCGA Application

Start Application

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DASHBOARD

AIM Program Application
USCGA AIM Application
Appli cant Information
Fami ly Information
Educati onal Information
Ex tr ac urri cular
Information
Additional Information

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Welcome, Alex! Your application is in progress.
Thank you for your interest in the United States Coast Guard Academy and the AIM Program. 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.

START APPLICATION
APPLICATION INSTRUCTIONS

Submit Application

Pers onal Statements
Important Links

Recommendati ons
Chec k Your Appl ic ati on
Appli cation Instruc ti ons

PRINT FORMS

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Submit Application

AIM Program Application
USCGA AIM Application

Applicant Information

Applicant Information

* Indicates a required field

Name

Fami ly Information
Educati onal Information

Legal First Name *

Ex tr ac urri cular
Information

Legal Middle Name

Additional Information

Legal Last Name *

Pers onal Statements

Suffix

N/A 

Important Links

Mailing Address
Recommendati ons
Chec k Your Appl ic ati on

Address Line 1 *
Address Line 2

Appli cation Instruc ti ons
City *

PRINT FORMS



State
Required if living in the U.S.

Country *

Select One



Zip or Postal Code *
#####

Telephone Numbers and Email

Primary Phone Number *
(###) ###-####

Alternate Phone Number *
(###) ###-####

International Phone Number
Email Address *
We will occasionally send official correspondence only via email, so please ensure you're
providing us an address you will maintain and check at least once a week.

Personal Information

Height *

Inches

Weight *

Pounds

Date of Birth *
(mm/dd/yyyy)
You must be 16-18 years old to attend the AIM Program

Gender *

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Marital Status *

Select One

Citizenship *

Select One

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


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

Other Country of Citizenship

Are you fluent in another language?*



Select One

Yes

No

If you are fluent (reading, speaking, and writing) in a language other than English, enter
the other language below.

Other Language(s)
Are you of Hispanic or Latino ethnicity
or heritage? *

Select One



Regardless of your answer to the previous question, please select all of the races which 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

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AIM Program Application
USCGA AIM Application
Appli cant Information

Family Information
* Indicates a required field

Parent/Guardian 1's Information

Family Information
Educati onal Information

Is your parent living? *

Ex tr ac urri cular
Information

Parent/Guardian 1's First Name

Additional Information

Yes

No

Parent/Guardian 1's Last Name

Pers onal Statements
Work Phone
Important Links

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

Home Phone
Recommendati ons

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

Chec k Your Appl ic ati on

International Phone Number

Appli cation Instruc ti ons

Email Address

PRINT FORMS

Occupation
Is your Parent/Guardian 1 a graduate
of one of the federal service
academies? *
Did your Parent/Guardian 1 graduate
from
college? *



Select One

Yes

No

College(s) attended (if any)



Highest Education Level

Select One

Was or is your Parent/Guardian 1 a
member of the armed forces? *

Select One

Highest Rank Held

Select One 



Parent/Guardian 1's Address

Does your Parent/Guardian 1 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
#####

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Is your parent living? *

Yes

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No

Parent/Guardian 2's First Name
Parent/Guardian 2's Last Name
Work Phone
(###) ###-####

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

International Phone Number
Email Address
Occupation
Is your Parent/Guardian 2 a graduate



Select One

of one of the federal service
academies? *
Did your Parent/Guardian 2 graduate
from
college? *

Yes

No

College(s) attended (if any)



Highest Education Level

Select One

Was or is your Parent/Guardian 2 a
member of the armed forces? *

Select One

Highest Rank Held

Select One 



Parent/Guardian 2's Address

Does your Parent/Guardian 2 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

Parents' Marital Status

Select One 

If you answered other, please
explain
If not with both parents, with whom do
you reside?
Do you have siblings?

Yes

No

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Submit Application

AIM Program Application
USCGA AIM Application
Appli cant Information

Educational Information

Fami ly Information

* Indicates a required field

Current High School
Educational Information
Type of School *
Ex tr ac urri cular
Information
Additional Information
Pers onal Statements

Select One 

If you are a home school student, and you cannot locate your program using the "Look up" system, please enter 777771 for
the CEEB code.
CEEB Code *

Look up

School Name *

Important Links
School Address *
Recommendati ons

City *

Chec k Your Appl ic ati on

State

Appli cation Instruc ti ons

PRINT FORMS

Country
Zip or Postal Code *
#####

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

Attended From *
mm/yyyy

Graduation Date *
mm/yyyy

Current GPA *

Please upload a copy of your most recent transcript, including any standardized test scores. Note: This field is mandatory
and the application cannot be submitted without a transcript.
e.g. .doc, .pdf, .txt, .xls More

Have you attended another high
school? *

Yes

No

Previous High School

Type of School

Select One 

If you are a home school student, and you cannot locate your program using the "Look up" system, please enter 777771 for
the CEEB code.
CEEB Code

Look up

School Name
School Address

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City
State
Country
Zip or Postal Code
#####

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

Attended From
mm/yyyy

Attended To
mm/yyyy

Colleges and Universities
If you currently attend or take classes at a college or university please enter the information below.
College Code

Look up

College/University Name
City
State
Zip or Postal Code
#####

Attended From
mm/yyyy

Attended To
mm/yyyy

Anticipated Senior Courses
Please list the courses you are planning to take during your senior year in high school. 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

What is your intended major? *

Are you a member of the National
Honor Society? *



Select One

Yes

No

Briefly list any academic honors you
received while in high school.

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Characters left in your response 300

Have you taken either the PSAT, SAT,
PLAN, or ACT exam? *

Yes

No

Standardized Test Scores

PSAT/NMQST/SAT Reading Score:
PSAT/NMQST/SAT Math Score:
PSAT/NMQST/SAT Writing Score:
PLAN/ACT Reading Score:
PLAN/ACT Math Score:
PLAN/ACT English or Writing Score:

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AIM Program Application
USCGA AIM Application
Appli cant Information

Extracurricular Information
* Indicates a required field

Fami ly Information

Activity 1
Educati onal Information
Please list the most meaningful extracurricular activities you have participated in.

Extracurricular
Information

Activity*



Select One

If other, please list activity.
Additional Information
Grade Level Participated*
Pers onal Statements

9
10
11

Important Links
Varsity Letter

9
10

Recommendati ons

11
Chec k Your Appl ic ati on
Appli cation Instruc ti ons

Team Captain

9
10
11

PRINT FORMS
Leadership Position

9
10
11

Achievements/Details
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 list activity.
Grade Level Participated

9
10
11

Varsity Letter

9
10
11

Team Captain

9
10
11

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9
10
11

Achievements/Details
If offered, I plan to participate in this

Yes

No

activity at the Academy
Coach/Advisor Name
Coach/Advisor Telephone Number
(###) ###-####

Activity 3

Activity



Select One

If other, please list activity.
Grade Level Participated

9
10
11

Varsity Letter

9
10
11

Team Captain

9
10
11

Leadership Position

9
10
11

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

Yes

No

Coach/Advisor Name
Coach/Advisor Telephone Number
(###) ###-####

Activity 4
Please list up to three additional extracurricular activites you'd like us to know about.
Activity

Select One



If other, please list activity.
Grade Level Participated

9
10
11

Varsity Letter

9
10
11

Team Captain

9
10
11

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11

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

Yes

No

Coach/Advisor Name
Coach/Advisor Telephone Number
(###) ###-####

Activity 5

Activity



Select One

If other, please list activity.
Grade Level Participated

9
10
11

Varsity Letter

9
10
11

Team Captain

9
10
11

Leadership Position

9
10
11

Achievements/Details
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 list activity.
Grade Level Participated

9
10
11

Varsity Letter

9
10
11

Team Captain

9
10
11

Leadership Position

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11

Achievements/Details
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
Employed From
mm/yyyy

Employed To
mm/yyyy

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

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AIM Program Application
USCGA AIM Application
Appli cant Information

Additional Information
* Indicates a required field

Fami ly Information

Medical Information
Educati onal Information
Ex tr ac urri cular
Information

Additional Information
Pers onal Statements
Important Links

Recommendati ons
Chec k Your Appl ic ati on
Appli cation Instruc ti ons

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Taking medication for ADHD/ADD,

Yes

No

Vision not correctable to 20/20 or
colorblind? *

Yes

No

In the past 2 years used an Inhaler, or
experienced difficulty breathing, been
diagnosed with any type of asthma, or
experienced severe cough after
exercising? *

Yes

No

Have you had any surgery in the last
12 calendar months? *

Yes

No

Are you allergic to or been diagnosed
with an allergy to any food products,
stinging insects, environmental
conditions or substance?*

Yes

No

mental health, or diabetes? *

If you answered yes to any of these
questions, please briefly explain.

Characters left in your response 500

USCGA Information

How did you first learn about the Coast
Guard Academy?

Select One



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AIM Program Application
USCGA AIM Application
Appli cant Information

Personal Statements

Fami ly Information

Personal Statements

Educati onal Information

Please include your name and the personal statement question at the top of each uploaded document; each personal
statement should be limited to one page.

Ex tr ac urri cular
Information
Personal Statement #1 *
Additional Information

Why do you want to attend the AIM Program and what are your expectations for
the one-week program?
e.g. .doc, .pdf, .txt, .xls More

Personal Statements
Personal Statement #2 *

The Coast Guard's core values are Honor, Respect and Devotion to Duty.
Describe what these words mean to you.

Important Links

Recommendati ons

e.g. .doc, .pdf, .txt, .xls More

Personal Statement #3

This essay is optional. Provide any additional information about yourself that you
feel we need to know and that you have not provided elsewhere in the application.

Chec k Your Appl ic ati on

e.g. .doc, .pdf, .txt, .xls More

Appli cation Instruc ti ons

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We require a letter of recommendation from your guidance counselor or appropriate school official. In addition, you may submit up to
two optional letters of recommendation from any source.
Individuals submitting letters of recommendation for your AIM application must submit them electronically through the online system to
ensure they are added to your record.

Appli cant Information
Fami ly Information
Educati onal Information
Ex tr ac urri cular
Information
Additional Information
Pers onal Statements

RECOMMENDATION PROVIDER LIST
Once the recommendation provider information is saved, an email will be sent to the online recommendation provider with instructions
on how to proceed with the online recommendation.

Additional Information
• Your Recommendations will automatically be matched to your application upon submission.
• The access code is valid for 180 days from the date you input and save their information.
• To complete the Recommendation online, a Recommendation provider must have a valid email address.
• If you would like to send a reminder, check the box next to his/her name and click on the "resend" button. This will automatically
generate a reminder email.

Important Links

Re commendations
Chec k Your Appl ic ati on
Appli cation Instruc ti ons

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Application Status: Incomplete
The following required questions have not been completed. Please note that this list refers only to the minimum number of
questions required by the system before submission is allowed. There may be many other questions on the form that should also be
answered; thus, please be sure you have fully responded to both required and relevant non-required items before you submit your
Application.

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SECTION NAME

QUESTION NAME

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Che ck Your
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Regardless of your answer to the previous question, please select all of
the races which best describe you. *

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Did your Parent/Guardian 1 graduate from
college? *

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Was or is your Parent/Guardian 1 a member of the armed forces? *

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Is your Parent/Guardian 1 a graduate of one of the federal service
academies? *

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Is your parent living? *

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Did your Parent/Guardian 2 graduate from
college? *

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Was or is your Parent/Guardian 2 a member of the armed forces? *

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academies? *

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Is your parent living? *

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What is your intended major? *

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Please upload a copy of your most recent transcript, including any
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application cannot be submitted without a transcript.

Extracurricular Information

Activity*

Extracurricular Information

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Coach/Advisor Telephone Number*

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

Additional Information

Taking medication for ADHD/ADD, mental health, or diabetes? *

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Vision not correctable to 20/20 or colorblind? *

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In the past 2 years used an Inhaler, or experienced difficulty breathing,
been diagnosed with any type of asthma, or experienced severe cough
after exercising? *

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products, stinging insects, environmental conditions or substance?*

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Personal Statement #1 *

Personal Statements

Personal Statement #2 *

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Application Instructions

Application Instructions
Please click here for Application Instructions.

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Application Support - Home

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Welcome to the Hobsons Applicant and Recommender Support Portal!
Here you can browse articles in our knowledge base and create a technical support case for assistance.
Thank you for the opportunity to assist you. A member of our team will contact you as soon as possible.
We provide support for applicants and recommendation providers during the following hours:
October 1st – March 31st: 8:00 a.m. - 12:00 a.m. ET (excluding holidays)
April 1st – September 30th: 8:00 a.m. – 6:00 p.m. ET on weekdays (excluding holidays)

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What is my application status?
FAQ - April 7, 2015
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FAQ - April 7, 2015
What to do if you would like to make a change to your submitted application.
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Submitting a new application if you have previously applied.
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Check Application Status: Complete

USCGA AIM Application
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Congratulations, Alex! All required questions have been completed. Please note that this refers only to the minimum number of
questions required by the system before submission is allowed. There may be many other questions on the form that should also be
answered; thus, please be sure you have fully responded to both required and relevant non-required items before you submit your
Application.
If you would like to begin the Application submission process, please click on the "proceed to submission" button below. Otherwise,
you may use the navigation links to access another section of the online Application.

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Application Status: Ready for Submission

USCGA AIM Application
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Educati onal Information

Congratulations, Alex! All required questions have been completed. Please note that this refers only to the minimum number of
questions required by the system before submission is allowed. There may be many other questions on the form that should also be
answered; thus, please be sure you have fully responded to both required and relevant non-required items before you submit your
Application.
Please review the print version of your Application before you submit by clicking on the link below. If you experience
difficulty viewing the document, please contact technical support. (Adobe Acrobat Reader is required to view this file. Download
Reader)

Ex tr ac urri cular
Information

PREVIEW APPLICATION IN PDF FORMAT

Additional Information
Pers onal Statements
Important Links

Recommendati ons
Chec k Your Appl ic ati on

Step 1: Confirmation
Be sure that you have carefully reviewed your responses and that you have answered all of the questions accurately. Your responses
will become the official property of the U.S. Coast Guard Academy and your admission to the Academy Introduction Mission (AIM)
Program will be based on the answers you have provided. You cannot change your answers through this form once they are
submitted. Please contact the admissions office if you need to update your application record.
To begin the submission process, check the box below and select the Continue button.
I have read and understand the above information and wish to submit this Application at this time. Please note: The Application
is not submitted until you see the words "Submission Complete!"

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Final Step: Signature Page
This is the final step in the application submission process. No changes to your application through the online system are allowed
once you enter your digital signature and click on the button below.
I certify that the information supplied by me on this application is true and correct to the best of my knowledge.

Fami ly Information
Educati onal Information
Full Name:
Ex tr ac urri cular
Information

Date:

2/7/2017

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Submit Application

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Submission Complete!

Appli cant Information
Fami ly Information
Educati onal Information

Your AIM Program application has been successfully submitted! All applications are reviewed during the month of April, so you should
expect to be notified in May whether or not you have been selected to attend. To learn more about the AIM Program, including how to
submit a request for scholarship funds to pay for your program fee and/or travel to the Academy, please visit
http://www.uscga.edu/AIM. Please remember to properly log out of your account before visiting a new website, thank you.

Ex tr ac urri cular
Information
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EnrollmentForm

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Congratulations on receiving an appointment to the 2017 AIM program. Please update or confirm the below
information. Completing enrollment to AIM is a three-step process:
1) Select an AIM session through your Bear's Den Account by May 19th
2) Submit tuition payment (on the next page) by June 1st
3) Submit all Enrollment Paperwork by June 1st

Step 1 - Enrollment Information
Name & Mailing Address

Legal First Name

Alex

Legal Middle Name

G

Legal Last Name

Eames

Suffix
Mailing Address

31 Mohegan Ave

City

New London

State



Connecticut
Required if living in the U.S.

Country

Zip or Postal Code



United States

06320-8103
#####

Telephone Numbers & Email

Primary Phone Number

(860) 701-6395
(###) ###-####

Alternate Phone Number

(000) 000-0000
(###) ###-####

International Phone Number
Email Address

[email protected]
We will occasionally send official correspondence only via email, so please ensure you're
providing us an address you will maintain and check at least once a week.

Acceptance Information
If you plan to participate, and are available for your assigned sesssion, in the AIM Program, select 'Yes' below. If your plans
or availability change, please notify the Admissions Office as soon as possible so a deserving alternate may attend in your
place.
If you do not plan to participate in the AIM Program, select 'No' below and provide the primary reason that you will not attend.
Will you participate in the AIM
Program? *
Primary reason you will not be
participating.

Yes

Select One

No



Departure Date:
Mode of Travel

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Step 2 - Enrollment Fee Payment
Thank you for completing your enrollment form. In order to finalize your enrollment in the AIM program, your tuition payment must be
received by June 1st. Your enrollment will not be processed until your enrollment deposit has been paid.
You may pay your enrollment deposit online here with your credit card. Visa, Mastercard, and American Express cards are accepted
and processed using a secure online payment system. To use your credit card, select the credit card payment option and click on the
submit button below. You will be directed to a separate, secure website where you will be prompted to enter your credit card
information. If the payment is successful, you will be returned to this enrollment site and will receive a final confirmation of your intent to
enroll.
Please note the enrollment form and payment will only hold your spot in the AIM program, you must also complete and submit your AIM
medical form by June 1st to complete your AIM acceptance process.

Enrollment Fee
$525

Select Payment Method
Credit Card
Fee Waiver

Click below to confirm the payment method indicated above and continue with the process of submitting your Enrollment. Note that payment authorization may take up to
a minute. Please be patient and do not click the submit button more than once.

Return to Enrollment Form

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TERMS AND CONDITIONS

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These terms and conditions are designed to provide you information on the services we provide and
outline important conditions which apply to your using this service. The internet bill presentment and
payment service is provide by Higher One, Inc.. and various third party vendors. It is subject to the

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Please accept agreement*

Payer Information
Please provide your information.
Applicant ID

04428739-151845

First Name*

Alex

Last Name*

Eames

Pay To
Pay To

Pay Amount

US Coast Guard Academy

$

525.00

Total: $ 525.00

Payment Method & Account Information
Please provide your payment type and payment account information.

Effective Payment
Date

2/7/2017

E-mail Address*
Credit Card

Payment Amount
Card Type*

$ 525.00
American Express

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Account Number*
Expiration Date*

02



2017



Name on Card*
Cardmember ID (CID)*

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AuthorAGEames
File Modified2017-02-07
File Created2017-02-07

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