FY17 USNA Selection Board

Name / First / MI / Last
Rank / Rank /
Unit / Unit /
DOR / DOR
MOS / MOS /
MOS Descriptor / MOS Descriptor /
Work Phone / Work Phone /
Cell Phone / Cell Phone /
Work Email / Work Email /
Home Email / Home Email /

Has your PMOS Monitor approved this application?Yes ☐ No ☐

EDUCATION

Civilian Education
School / Degree / Year
School / Degree / Year
School / Degree / Year
School / Degree / Year
School / Degree / Year
School / Degree / Year
School / Degree / Year
Professional Education
School/ Course/ Year
School / Course / Year
School / Course / Year
School / Course / Year
School / Course / Year
School / Course / Year
School / Course / Year
School / Course / Year
School / Course / Year
School / Course / Year
School / Course / Year
School / Course / Year
School / Course / Year
School / Course / Year
School / Course / Year
School / Course / Year

PERSONAL INFORMATION

Home of Record / HoR /
Married / Yes ☐ No ☐
Military Spouse / Yes ☐ No ☐

CHRONOLOGICAL RECORD OF MILITARY SERVICE

Date Departed / Unit/ Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet

OPERATIONAL HISTORY

Operation / Unit/ Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet
Date Departed / Unit / Billet

PERSONAL STATEMENT

BRIEFLY DESCRIBE WHY YOU WANT TO SERVE AT THE UNITED STATES NAVAL ACADEMY AND HOW YOU WILL ENHANCE OUR MISSION OF RECRUITING, TRAINING, SCREENING AND SELECTING MARINE OFFICERS:

Personal Statement

ONCE YOU HAVE BEEN APPROVED BY YOUR PRIMARY MOS MONITOR TO APPLY FOR ASSIGNMENT TO USNA, RETURN THIS APPLICATION, A CURRENT BOARD PHOTO, ACADEMIC TRANSCRIPTS AND ANY LETTERS OF RECOMMENDATION TO LTCOL WEIS, .