2015 Supplemental Forms

Supplemental Forms Package - Class of 2015

PRINT SINGLE SIDED This package includes the following supplemental forms:

• High School Transcript • Math Instructor Evaluation • English Instructor Evaluation • Coach or P.E. Instructor Evaluation • Commanding Officer Recommendation (if currently serving in the military) • College Transcript (if you are or were in college) • Physical Fitness Examination (PFE) Scoring Form • PFE Instruction Manual and Scoring Table

We recommend returning all forms together, but you may submit them individually to: Director of Admissions (tp) U.S. Coast Guard Academy 31 Mohegan Avenue New London, CT 06320 All forms must be postmarked by February 1, 2011 (October 15, 2010 or November 1, 2010 for Early Action) for you to be considered for an appointment to the U.S. Coast Guard Academy. We will not accept faxed copies of completed supplemental forms, but scanned copies of completed supplemental forms may be submitted electronically to [email protected]. Please Note: We will accept the Candidate Fitness Assessment (CFA) in lieu of the PFE Scoring Form enclosed in this forms package. Whenever possible, the CFA should have been administered after July 1, 2010 and be a signed original, a copy of the original re-signed/dated by the applicant and administrator, or received directly from another federal service academy. Depending on your CFA score, you may be asked to complete and submit the PFE. Even if your CFA score is acceptable, we highly recommend that you take the PFE, as this is the standard which you will be held to at the U.S. Coast Guard Academy. If you completed the PFE during the AIM Program, you are not required to take the exam again if you scored at least 130 points; however, we recommend retaking the exam until you’ve scored at least 165 points. Contact your Admissions Officer if you need to confirm your PFE score from AIM.

PRINT SINGLE SIDED

U.S. Dept. of Homeland Security, USCG, CGA-14A (Rev. 08-10) OMB No. 1625-0004 Expires 12/31/2011 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 18 minutes. You may submit any comments concerning the accuracy of this estimate or any suggestions for reducing the burden to: U.S. Coast Guard Academy, 31 Mohegan Avenue, New London, CT 06320, or Department of Homeland Security Desk Officer, Office of Management and Budget, Office of Information and Regulatory Affairs, Washington, D.C. 20503.

U.S. Coast Guard Academy

High School

Transcript

Director of Admissions (tp) U.S. Coast Guard Academy

31 Mohegan Avenue New London, CT 06320

800-883-8724 (phone)

www.uscga.edu

[email protected]

Privacy Act Statement. In accordance with 5 USC 552a(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. (3) Routine uses which may be made of the info: As background info on applicants for the selection process. To contact the applicant. The SSN is a basic identifier. To determine if there are existing USCG records on the individual. In performance of the duties of officials and employees of the USCG, in managing and contributing to the admissions program and appointment of Cadets. (4) Disclosure of the information is voluntary, but the applicant will not be considered further if the information is not provided. Submissions of the Evaluator will not be disclosed to the applicant without consent.

Please provide the information requested in Section 1. On the front of an envelope, print the following four lines of information: (1) Your Name; (2) The last four digits of your SSN; (3) High School Transcript; and (4) U.S. Coast Guard Academy. Provide this form and the envelope to your guidance counselor and request that your transcript and this form be returned to you in the sealed envelope. This form must be postmarked, and returned to the Admissions Office along with your other forms, by February 1st. Section 1: Name: _________________________________________________________ Last Four Digits of SSN: __________________ City: __________________________________________ State: _____________ Zip Code: _________________________ Telephone: ____________________________________ Email: ___________________________________________________

Section 2: The above student is applying to the U.S. Coast Guard Academy. Please complete this form and attach the following:

(1) An official transcript of grades through (at least) the end of the applicant’s junior year; (2) A list of courses in progress, including classes scheduled for the applicant’s senior year; (3) Any known SAT or ACT scores taken without accommodation(s); (4) A school profile; and (5) A separate letter of recommendation that discusses how well this student will: 1) Perform in a challenging academic

environment; and 2) Demonstrate respect and compassion toward others. Please seal all materials and this form in the envelope provided by the applicant. Sign your name over the envelope seal to ensure confidentiality and return it to the student. Thank you for your time and assistance. Applicant Info:

Month/Year of Graduation: _______________ Ranking Period (mm/yy) __________ to __________ Cumulative GPA: _______________________ GPA Scale (4.0, 5.0 etc): ___________________________ Rank in Class: __________________________ Number of Students: ______________________________ If rank is unavailable, indicate the approximate placement percentile (Top 10% etc): __________________

High School Info:

Official Name of School: _____________________________________________________________________ ETS Code: _____________________________________ Phone Number: __________________________ City: _______________________________ State: ______________ Zip Code: _____________________ Percentage of class expected to enter 4 year college: _________________ 2 year college: _________________ Type of School (Public, Private, etc.): _________ ___________________________________________________

Counselor Name: ______________________________________ Title: ___________________________________ Signature: ____________________________________________ Date: ___________________________________

U.S. Dept. of Homeland Security, USCG, CGA-14B (Rev. 08-10) OMB No. 1625-0004 Expires 12/31/2011 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 15 minutes. You may submit any comments concerning the accuracy of this estimate or any suggestions for reducing the burden to: U.S. Coast Guard Academy, 31 Mohegan Avenue, New London, CT 06320, or Department of Homeland Security Desk Officer, Office of Management and Budget, Office of Information and Regulatory Affairs, Washington, D.C. 20503.

Top 1%

Top 10%

Above Average

Average

Below Average

Not Observed

Commitment to learning and personal growth

Gains respect from peers

Exerts maximum effort showing a strong desire to achieve in every fieldSets high standards for own performance in a variety of pursuitsConsistently respects othersTakes action to include group members who are struggling or left out

Communicates effectively in written workTakes advantage of opportunities to reach full potentialAccepts criticism and makes improvementsAdjusts to a demanding schedule of activities without neglecting school work

Commitment to learning and personal growthCommitment to a healthy lifestyleAbility to think criticallyCommunicates effectively face to face


Math Instructor Evaluation



800-883-8724 (phone)

www.uscga.edu

[email protected]


Please provide the information requested in Section 1. On the front of a blank envelope, print the following four lines of information: (1) Your Name; (2) The last four digits of your SSN; (3) Math Instructor Evaluation; and (4) U.S. Coast Guard Academy. Provide this form and the envelope to your math instructor and request that the form be returned to you in the sealed envelope. This form must be postmarked, and returned to the Admissions Office along with your other supplemental forms, by February 1st. Section 1: Name: _________________________________________________________ Last Four Digits of SSN: __________________ City: __________________________________________ State: _____________ Zip Code: _________________________ Telephone: ____________________________________ Email: ___________________________________________________

Section 2: The above student is applying to the U.S. Coast Guard Academy. Please complete this form and seal it in the envelope provided by the applicant. Sign your name over the envelope seal to ensure confidentiality and return it to the student. On the back of this form or in a separate letter of recommendation, please discuss how well this student will: 1) Perform in a rigorous technical curriculum; and 2) Demonstrate respect and compassion toward others. Thank you for your time and assistance. Please check the appropriate box: Name: ______________________________________ Title: ______________________________________________________ Signature: __________________________________ Date: _________________ Telephone: _________________________

Did you stipulate confidentiality as a condition for providing information? (Please circle one)

Yes No

Do you have low, average, or high familiarity with this applicant? (Please circle one)

Low Average High

U.S. Dept. of Homeland Security, USCG, CGA-14 (Rev. 08-10) OMB No. 1625-0004 Expires 12/31/2011 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 15 minutes. You may submit any comments concerning the accuracy of this estimate or any suggestions for reducing the burden to: U.S. Coast Guard Academy, 31 Mohegan Avenue, New London, CT 06320, or Department of Homeland Security Desk Officer, Office of Management and Budget, Office of Information and Regulatory Affairs, Washington, D.C. 20503.

Top 1%

Top 10%

Above Average

Average

Below Average

Not Observed







English Instructor Evaluation



800-883-8724 (phone)

www.uscga.edu

[email protected]


Please provide the information requested in Section 1. On the front of a blank envelope, print the following four lines of information: (1) Your Name; (2) The last four digits of your SSN; (3) English Instructor Evaluation; and (4) U.S. Coast Guard Academy. Provide this form and the envelope to your English instructor and request that the form be returned to you in the sealed envelope. This form must be postmarked, and returned to the Admissions Office along with your other supplemental forms, by February 1st. Section 1: Name: _________________________________________________________ Last Four Digits of SSN: __________________ City: __________________________________________ State: _____________ Zip Code: _________________________ Telephone: ____________________________________ Email: ___________________________________________________

Section 2: The above student is applying to the U.S. Coast Guard Academy. Please complete this form and seal it in the envelope provided by the applicant. Sign your name over the envelope seal to ensure confidentiality and return it to the student. On the back of this form or in a separate letter of recommendation, please discuss how well this student will: 1) Perform in a rigorous curriculum infused with writing requirements; and 2) Demonstrate respect and compassion toward others. Thank you for your time and assistance. Please check the appropriate box: Name: ______________________________________ Title: ______________________________________________________ Signature: __________________________________ Date: _________________ Telephone: _________________________


Yes No


Low Average High

U.S. Dept. of Homeland Security, USCG, CGA-14C (Rev. 08-10) OMB No. 1625-0004 Expires 12/31/2011 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 15 minutes. You may submit any comments concerning the accuracy of this estimate or any suggestions for reducing the burden to: U.S. Coast Guard Academy, 31 Mohegan Avenue, New London, CT 06320, or Department of Homeland Security Desk Officer, Office of Management and Budget, Office of Information and Regulatory Affairs, Washington, D.C. 20503.

Top 1%

Top 10%

Above Average

Average

Below Average

Not Observed







Coach or P.E. Instructor

Evaluation



800-883-8724 (phone)

www.uscga.edu

[email protected]


Please provide the information requested in Section 1. On the front of a blank envelope, print the following four lines of information: (1) Your Name; (2) The last four digits of your SSN; (3) Coach/P.E. Instructor Evaluation; and (4) U.S. Coast Guard Academy. Provide this form and the envelope to your coach or P.E. instructor and request that the form be returned to you in the sealed envelope. This form must be postmarked, and returned to the Admissions Office along with your other supplemental forms, by February 1st. Section 1: Name: _________________________________________________________ Last Four Digits of SSN: __________________ City: __________________________________________ State: _____________ Zip Code: _________________________ Telephone: ____________________________________ Email: ___________________________________________________

Section 2: The above student is applying to the U.S. Coast Guard Academy. Please complete this form and seal it in the envelope provided by the applicant. Sign your name over the envelope seal to ensure confidentiality and return it to the student. On the back of this form or in a separate letter of recommendation, please discuss how well this student will: 1) Meet the rigorous physical demands of a military service academy; 2) Demonstrate respect and compassion toward others; and 3) Compete in a NCAA Division III varsity sport. Thank you for your time and assistance.

Please check the appropriate box: Name: ______________________________________ Title: ______________________________________________________ Signature: __________________________________ Date: _________________ Telephone: _________________________


Yes No


Low Average High

U.S. Dept. of Homeland Security, USCG, CGA Form (Rev. 08-10) OMB No. 1625-0004 Expires 12/31/2011

Top 1%

Top 10%

Above Average

Average

Below Average

Not Observed


Gains respect from subordinates, peers, and seniors


Communicates effectively in written workTakes advantage of opportunities to reach full potentialAccepts criticism and makes improvementsAdjusts to a demanding schedule of activities without neglecting primary duties



Commanding Officer

Recommendation



800-883-8724 (phone)

www.uscga.edu

[email protected]


ONLY FOR APPLICANTS CURRENTLY SERVING IN THE MILITARY Please provide the information requested in Section 1. On the front of a blank envelope, print the following four lines of information: (1) Your Name; (2) The last four digits of your SSN; (3) Commanding Officer Recommendation; and (4) U.S. Coast Guard Academy. Provide this form and the envelope to your Commanding Officer or Officer-In-Charge and request that the form be returned to you in the sealed envelope. This form must be postmarked, and returned to the Admissions Office along with your other supplemental forms, by February 1st. Section 1: Name: _________________________________________________________ Last Four Digits of SSN: __________________ City: __________________________________________ State: _____________ Zip Code: _________________________ Telephone: ____________________________________ Email: ___________________________________________________ Current Unit: __________________________________________________________ Months at Unit: __________ Previous Unit: __________________________________________________________ Months at Unit: __________

Section 2: The above member is applying to the U.S. Coast Guard Academy. We request that you prepare a letter of recommendation on your letterhead addressing the member’s current duties and performance, leadership potential, ability to acquire and integrate knowledge, commitment to personal growth, motivation to reach full potential, and conformance with Core Values. In addition, please discuss the ways in which the member will likely contribute to the experience of other cadets and the Academy community. Please attach your letter to this form and seal it in the envelope provided by the member. Sign your name over the envelope seal to ensure confidentiality and return it to the member. Please direct questions to the Academy’s Admissions Operations Branch at (860) 701-6778. Please check the appropriate box: Name: ______________________________________ Title: ______________________________________________________ Signature: __________________________________ Date: _________________ Telephone: _________________________



College Transcript



800-883-8724 (phone)

www.uscga.edu

[email protected]


ONLY FOR APPLICANTS WITH COLLEGE EXPERIENCE Please provide the information requested in Section 1. Provide this form to the Registrar of your college or university and request that an official transcript be mailed to the U.S. Coast Guard Academy at the address above. If the Registrar can release an official transcript to you in a sealed envelope, you may submit it with your other supplemental forms. To be considered, the transcript must be postmarked and returned to the Admissions Office by February 1st. Please Note: If you have graduated high school and are currently attending college, you must provide a complete college transcript from the fall semester of the year before entry. If you are currently in high school and taking college courses as a supplement to your required curriculum, you may provide the college grades available at the time of application. Section 1: Name: _________________________________________________________ Last Four Digits of SSN: __________________ Street Address: _____________________________________________________________________________________________ City: __________________________________________ State: _____________ Zip Code: _________________________ Telephone: ____________________________________ Email: ___________________________________________________ I request that my official transcript from ___________________________________________________________________________ be mailed to the U.S. Coast Guard Academy, Director of Admissions (tp), 31 Mohegan Avenue, New London, CT 06320. Applicant Signature: ______________________________________________________ Date: ___________________________

Section 2: The above student is applying to the U.S. Coast Guard Academy. Please attach an official transcript to this form (or a copy of this form) and mail it to the address at the top of this form. Alternatively, you may provide the transcript directly to the applicant in a sealed envelope. Please note that transcripts must be postmarked by February 1st to be considered. Please direct questions to the Academy’s Admissions Operations Branch at (860) 701-6775. Thank you for your time and assistance.

U.S. Dept. of Homeland Security, USCG, CGA-14D (Rev. 08-10) OMB No. 1625-0004 Expires 12/31/2011 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 1 hour. You may submit any comments concerning the accuracy of this estimate or any suggestions for reducing the burden to: U.S. Coast Guard Academy, 31 Mohegan Avenue, New London, CT 06320, or Department of Homeland Security Desk Officer, Office of Management and Budget, Office of Information and Regulatory Affairs, Washington, D.C. 20503.


Physical Fitness Examination (PFE)

Scoring Form



800-883-8724 (phone)

www.uscga.edu

[email protected]


Please provide the information requested in Section 1. Ask either a coach or physical education instructor to administer this examination, providing him/her this form and a copy of the PFE Instruction Manual in advance. Ensure the examiner completes Section 2 and signs the form in pen after you’ve completed all events. Confirm your raw scores/points before signing the form yourself. This form must be postmarked, and returned to the Admissions Office along with your other supplemental forms, by February 1st. Section 1: Name: _________________________________________________________ Last Four Digits of SSN: __________________ City: __________________________________________ State: _____________ Zip Code: _________________________ Telephone: ____________________________________ Email: ___________________________________________________

Section 2: The above student is applying to the U.S. Coast Guard Academy, where physical fitness is essential to cadet performance. If accepted to the Academy, the applicant will retake this examination shortly after Reporting-In Day and incoming cadets who receive a failing score will be disenrolled, so accurate reporting is critical. Please administer the examination in accordance with the PFE Instruction Manual (provided by the student) and then complete the table below in pen. Raw score is converted to points by consulting the scoring table within the PFE Instruction Manual. Please direct questions to the Academy’s Admissions Operations Branch at (860) 701-6776. Thank you for your time and assistance.

Event Raw Score Points

1) CADENCE PUSH-UPS push-ups

2) TWO MINUTE SIT-UPS sit-ups

3) 1.5 MILE RUN

min sec

Total Points

Body Measurements

1) HEIGHT inches 2) WEIGHT pounds Coach/Instructor Name: _____________________________________ Title: _________________________________________ Signature: ________________________________ Date: _________________ Telephone: _________________________

By signing this form, I certify that the raw scores/points above are accurate. In addition, I understand that all incoming cadets must retake this evaluation shortly after Reporting-In Day and anyone failing to meet the passing standard will be disenrolled. Applicant Signature: _______________________________________________ Date: ________________________________

Cadet Candidate Physical Fitness Examination

Instruction Manual and

Scoring Table

Rev. 08/10/2010

For questions or interpretations of any material included in this manual contact:

Chris McMunn Associate Director for Operations U.S. Coast Guard Academy Admissions 31 Mohegan Avenue New London, CT 06320 [email protected]

FOREWORD

Life as a Coast Guard Academy cadet - and later as a junior officer - is physically demanding. In addition to being required to participate in sports each year, cadets are required to take a Physical Fitness Examination (PFE) each semester. Experience indicates that individuals who cannot meet, or struggle to meet, our physical fitness standards are more likely to leave the Academy during the first few weeks of Swab Summer. To ensure that we are enrolling physically fit young men and women, cadet candidates are required to take the PFE as part of the application process.

2

ADMINISTERING THE PFE TO CADET CANDIDATES

The PFE is a 300-point test consisting of three elements worth a maximum of 100 points each. It must be administered in the following sequence with a maximum rest period of five minutes in between the events. 1. Cadence Push-Ups

2. Two-Minute Sit-Ups 3. 1.5 Mile Run

The candidate should ask either a coach or physical education instructor to administer the PFE. Before scheduling the test, the candidate should practice each event and concentrate on improving any weaknesses. On the day of the test, the candidate should be dressed in comfortable work-out clothing and running shoes; the candidate should arrive early enough to complete a thorough and active warm-up routine. The examiner should review this manual and the PFE Scoring Form prior to the exam and have prepared an emergency action plan for medical assistance, if required. All necessary equipment for each event should be set-up before the test begins. All results should be marked in pen on the PFE Scoring Form. At the beginning of the exam, the examiner should measure the height and weight of the candidate in gym shorts and t-shirt (no shoes), recording these results at the bottom of the PFE Scoring Form. After all events have been completed, use the scoring table contained in this manual to convert raw scores to points for each event; calculate and record the total score. The examiner must provide contact information and both individuals should sign the form. By signing/submitting the form, the examiner and candidate are confirming that the exam was administered according to the instructions in this manual and that raw scores/points are true. Scores must come from a single test session and cannot be pieced together from multiple sessions or practice tests.

CADET PFE STANDARDS

All cadets at the Coast Guard Academy are required to pass the PFE at the beginning of each semester. The standard for graduation and commissioning is 200 points and cadets should always strive to achieve this score. Any cadet who scores below 165 points will be recommended for suspended disenrollment and may be recommended for immediate disenrollment based on previous PFE performance. There is not a prescribed minimum performance for each individual event on the PFE; only total scores are assessed. Score Letter Grade Score Letter Grade 285-300 Max Club 200-221 C 258-284 A 165-199 D 222-257 B 0-164 F New cadets take the PFE during the first week of Swab Summer. Cadets who score less than 130 points on this first test are normally disenrolled. By the end of Swab Summer, usually the third week in August, new cadets are expected to score at least 165 points. Cadets unable to achieve this score by the end of the first academic semester, usually the second week in December, are normally disenrolled. Consequently, an applicant who cannot attain a score of at least 130 points will not receive a full appointment. This standard may be raised based on the competitiveness of the applicant pool and the needs of the Coast Guard.

CLASS OF 2014 PERFORMANCE For your information and comparison, the following is a table of mean performances by the Class of 2014 from their initial Swab Summer Physical Fitness Examination in July 2010:

Event Men Women 1. Cadence Push-Ups 36 22 2. Two Minute Sit-Ups 78 71 3. 1.5 Mile Run 10:17 12:00

3

EVENT 1

CADENCE PUSH-UPS Equipment: A stopwatch. Description: Push-Ups must be completed to cadence, with one push-up completed every two seconds for a maximum of 60 in two minutes. The examiner should give the “up” command at one second and “down” at the next. At the start of the event, lie on your stomach with your hands shoulder-width apart (directly under your shoulders); fingers should be facing forward; elbows are bent. On the “up” command, elbows are locked, body straight, hips may not be flexed (Figure 1). On the “down” command, back is straight with elbows bent to at least 90 degrees (Figure 2). Continue doing push-ups, staying on cadence, for as long as possible. No resting is permitted and your hand position cannot be changed. The event is finished when push-ups are not properly executed, you cannot stay with the cadence, or two minutes has passed. Precautions: Resting is not allowed; do not lift your hands off the ground or change hand position; keep your body straight at all times; hips may not flex and buttocks should remain in line with your back and legs. Scoring: Record the total number of properly executed push-ups. If the candidate is able to stay with cadence for two minutes, the maximum raw score is 60.

Figure 1 Figure 2 Proper Up Position Proper Down Position

EVENT 2 TWO-MINUTE SIT-UPS

Equipment: Gymnasium mat and a stopwatch. Description: Lie on your back with your knees flexed so that your feet are flat on the floor and eight to twelve inches from your buttocks. Have someone hold your feet firmly; cross your arms across your chest with your hands firmly grasping your t-shirt above your shoulders (Figure 3). When the examiner begins the event with the “go” command, curl your torso up so your arms touch your thighs (Figure 4), then return to the start position (Figure 3). Repeat as many times as possible in two minutes. Precautions: A sit-up will not count if you do not maintain the above form or if you allow your arms to swing away from the body during the sit-up. Scoring: Record the number of properly executed sit-ups performed in a two-minute period. Figure 3 Figure 4 Start/Finish Position Proper Sit-Up Position

4

EVENT 3 1.5 MILE RUN

Equipment: A measured 1.5 mile course and a stopwatch. Description: You will cover the 1.5 mile course in the fastest possible time. Precautions: You must be physically prepared for this event. If you become winded, or have a muscle cramp, you may walk; however, you must stay within the 1.5 mile course. This event may not be completed on a treadmill or other exercise machine. Scoring: Record the time, to the nearest second, that it takes to complete the 1.5 mile course.

CADET CANDIDATE PFE SCORING TABLE

Points Event 1 Event 2 Event 3 Points Push-Ups Sit-Ups 1.5 Mile Run Number Number Min : Sec Men Women Men Women Men Women

100 60 48-60 100+ 100+ <8:00-8:04 <9:55-9:59 100 99 99 99 99 98 59 47 98 98 8:05-8:09 10:00-10:04 98 97 97 97 97 96 58 46 96 96 8:10-8:14 10:05-10:09 96 95 95 95 95 94 57 45 94 94 8:15-8:19 10:10-10:14 94 93 93 93 93 92 56 44 92 92 8:20-8:24 10:15-10:19 92 91 91 91 91 90 55 43 90 90 8:25-8:29 10:20-10:24 90 89 89 89 89 88 54 42 88 88 8:30-8:34 10:25-10:29 88 87 53 87 87 87 86 52 41 86 86 8:35-8:39 10:30-10:34 86 85 51 40 85 85 85 84 50 39 84 84 8:40-8:44 10:35-10:39 84 83 49 38 83 83 83 82 48 37 82 82 8:45-8:49 10:40-10:44 82 81 47 36 81 81 81 80 46 35 80 80 8:50-8:54 10:45-10:49 80 79 45 34 79 79 79 78 44 33 78 78 8:55-8:59 10:50-10:54 78 77 43 32 77 77 77 76 42 31 76 76 9:00-9:04 10:55-10:59 76 75 41 30 75 75 75 74 40 29 74 74 9:05-9:10 11:00-11:04 74 73 39 28 73 73 9:10-9:14 73 72 38 27 72 72 9:15-9:19 11:05:11:09 72 71 37 26 71 71 9:20-9:24 11:10-11:14 71 70 36 25 70 70 9:25-9:29 11:15-11:19 70 69 35 24 69 69 9:30-9:34 11:20-11:24 69 68 34 23 68 68 9:35-9:39 11:25-11:29 68 67 33 22 67 67 9:40-9:44 11:30-11:34 67 66 32 21 66 66 9:45-9:49 11:35-11:39 66 65 31 20 65 65 9:50-9:54 11:40-11:44 65 64 30 19 64 64 9:55-9:59 11:45-11:49 64 63 29 18 63 63 10:00-10:04 11:50-11:54 63 62 28 62 62 10:05-10:09 11:55-11:59 62 61 27 17 61 61 10:10-10:14 12:00-12:04 61 60 26 60 60 10:15-10:19 12:05-12:09 60 59 16 59 59 10:20-10:24 12:10-12:14 59 58 25 58 58 10:25-10:29 12:15-12:19 58 57 15 57 57 10:30-10:34 12:20-12:24 57 56 24 56 56 10:35-10:39 12:25-12:29 56 55 14 55 55 10:40-10:44 12:30-12:34 55 54 23 54 54 10:45-10:49 12:35-12:39 54 53 13 53 53 10:50-10:54 12:40-12:44 53 52 22 52 52 10:55-10:59 12:45-12:49 52 51 12 51 51 11:00-11:04 12:50-12:54 51

Points Event 1 Event 2 Event 3 Points Push-Ups Sit-Ups 1.5 Mile Run Number Number Min : Sec Men Women Men Women Men Women

50 21 50 50 11:05-11:09 12:55-12:59 50 49 49 49 11:10-11:14 13:00-13:04 49 48 20 11 48 48 11:15-11:19 13:05-13:09 48 47 47 47 11:20-11:24 13:10-13:14 47 46 19 46 46 11:25-11:29 13:15-13:19 46 45 10 45 45 11:30-11:34 13:20-13:24 45 44 18 44 44 11:35-11:39 13:25-13:29 44 43 43 43 11:40-11:44 13:30-13:34 43 42 17 9 42 42 11:45-11:49 13:35-13:39 42 41 41 41 11:50-11:54 13:40-13:44 41 40 16 40 40 11:55-11:59 13:45-13:49 40 39 8 39 39 12:00-12:04 13:50-13:54 39 38 15 38 38 12:05-12:09 13:55-13:59 38 37 37 37 12:10-12:14 14:00-14:04 37 36 14 7 36 36 12:15-12:19 14:05-14:09 36 35 35 35 12:20-12:24 14:10-14:14 35 34 13 34 34 12:25-12:29 14:15-14:19 34 33 6 33 33 12:30-12:34 14:20-14:24 33 32 12 32 32 12:35-12:39 14:25-14:29 32 31 11 31 31 12:40-12:44 14:30-14:34 31 30 10 5 30 30 12:45-12:49 14:35-14:39 30 29 29 29 12:50-12:54 14:40-14:44 29 28 28 28 12:55-12:59 14:45-14:49 28 27 27 27 13:00-13:04 14:50-14:54 27 26 26 26 13:05-13:09 14:55-14:59 26 25 25 25 13:10-13:14 15:00-15:04 25 24 24 24 13:15-13:19 15:05-15:09 24 23 23 23 13:20-13:24 15:10-15:14 23 22 22 22 13:25-13:29 15:15-15:19 22 21 21 21 13:30-13:34 15:20-15:24 21 20 20 20 13:35-13:39 15:25-15:29 20 19 19 19 13:40-13:44 15:30-15:34 19 18 18 18 13:45-13:49 15:35-15:39 18 17 17 17 13:50-13:54 15:40-15:44 17 16 16 16 13:55-13:59 15:45-15:49 16 15 15 15 14:00-14:04 15:50-15:54 15 14 14 14 14:05-14:09 15:55-15:59 14 13 13 13 14:10-14:14 16:00-16:04 13 12 12 12 14:15-14:19 16:05-16:09 12 11 11 11 14:20-14:24 16:10-16:14 11 10 10 10 14:25-14:29 16:15-16:19 10 9 9 9 14:30-14:34 16:20-16:24 9 8 8 8 14:35-14:39 16:25-16:29 8 7 7 7 14:40-14:44 16:30-16:34 7 6 6 6 14:45-14:49 16:35-16:39 6 5 5 5 14:50-14:54 16:40+ 5 4 4 4 14:55-14:59 4 3 3 3 15:00-15:04 3 2 2 2 15:05-15:09 2 1 1 1 15:10-15:14 1 0 0 0 15:15+ 0



Physical Fitness Examination

Practice Form



800-883-8724 (phone)

www.uscga.edu

[email protected]


PRACTICE FORM

This is a practice form intended to familiarize you with the Physical Fitness Exam that all applicants must take; it will not count for your application. Once you complete our online application, you will have access to a Supplemental Forms Package and the actual Physical Fitness Examination Scoring Form. In order to best prepare yourself for the exam, we recommend you follow all directions in the Physical Fitness Examination Instruction Manual when taking practice exams. Please direct questions to the Academy’s Admissions Operations Branch at (860) 701-6776. Good luck!




3) 1.5 MILE RUN

min sec

Total Points




3) 1.5 MILE RUN

min sec

Total Points




3) 1.5 MILE RUN

min sec

Total Points

PRACTICE FORM

Documents

2015 Supplemental Forms