Please complete the following request form and send to:
Office of Congressman Joe Baca 201 North "E" Street, Suite 102 San Bernardino, CA 92401
Preference: Air Force Annapolis West Point Merchant Marine
First Name: M.I. Last Name:
Legal Residence:
Mailing Address (if different from above):
Telephone:
Date of Birth: Social Security Number:
Name of Parents or Guardian:
High School Attended: GPA:
Rank in Class/Total Class Size (20th of 200, 4th of 25, etc.):
College Attended (if any):
Extracurricular Activities:
Please indicate any condition requiring medical attention:
Are you applying for nomination from another source? If so, who?: