Academy Admissions Partner Portal

Registration Form

By submitting this registration request, you are indicating your interest in becoming an Academy Admissions Partner. The Associate Director of Admissions for Volunteer Programs or a member of the Admissions team will contact you to discuss the program and how you can help. Thank you for your interest in this program.

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Fields marked with an * are required.

Personal Information

Title/Rank

First Name *

Middle Initial

Last Name *

Nickname

Maiden Name (if applicable)

Address *

Address 2

City *

State *

Country *

Zip Code *

Home Phone *
( ) -

Work Phone (optional)
( ) -

Cell Phone (optional)
( ) -

Email Address *

Highest Degree Earned

Employment Status

Birth Date *
/ / Month / Day / Year

Additional Information

Please check service affiliations that apply: *

USCGA Alumna/Alumnus

Year:

USCGA Cadet Parent

Year:

USCGA Cadet

Year:

USCG Auxiliarist

Division

Coast Guard Employee

Other Military

Friend of Coast Guard

If Military:

Active Duty

Reserve

Retired

Separated

Please select Gender:

Male

Female

Please check all that apply:

Hispanic or Latino

Black or African American

Asian

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

White

Other

Please check all memberships that apply:

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