(all information is mandatory for consideration)

EDUCATOR:
NAME (last, First):

STREET:

CITY/STATE: ZIP CODE:

HOME PHONE:   And/or  HOME E-MAIL:

HIGH SCHOOL:
SCHOOL NAME:

SCHOOL ADDRESS:

CITY: STATE: ZIP CODE:   ETS CODE:

SCHOOL PHONE:   SCHOOL E-MAIL:

POSITION AT SCHOOL:

HOW LONG HAVE YOU BEEN AN EDUCATOR:

PERCENTAGE OF STUDENTS THAT GO ON TO COLLEGE: 

PERCENTAGE OF DIVERSE* STUDENTS IN YOUR SCHOOL:

*“What is Diversity? The Air Force Academy defines “diversity” as “a composite of individual characteristics that includes personal life experiences (including having overcome adversity by personal efforts), geographic background (e.g., region, rural, suburban, urban), socioeconomic background, cultural knowledge, educational background (including academic excellence, and whether an individual would be a first generation college student), work background (including prior enlisted service), language abilities (with particular emphasis on languages of strategic importance to the Air Force), physical abilities (including athletic prowess), philosophical/spiritual perspectives, age (cadet applicants must be within statutory parameters for academy attendance), race, ethnicity and gender.”

Reason(s) for wanting to attend:

How did you hear about this program?

 Admissions Liaison Officer 

 AcademyAdmissions.com Website 

 Contact with USAF Academy Staff Member (Admissions representative, etc.) 

 Word-of-Mouth from another Educator

 Had attended another Service Academy’s Program.   Inquired about the USAF Academy.

 Other – Explain

REFERRED BY:
 ALO: (or) ID:


or Print and RETURN THIS FORM TO:
Lt Col Robert Hazlett, 2703 Crystal Cir, Arlington, TX  76006-3709

DEADLINE FOR CONSIDERATION:  19 JUNE 2010

Northeast Texas High School Address/ETS Code Look-up (optional):