3Q. If you are qualified in all 3 areas, academically, physically, and medically, and you have a nomination, in your case a principal nomination, then you WILL receive an appointment.
This is assuming your nomination IS a principal. There are 3 types of nomination you could have from your senator or representative. Also, assuming you gpa and act/sat meet the minimums required, then you will receive the appointment.
I say assuming, because it's possible your act is too low. Does your online portal say qualified or disqualified. Also, some people have been told by the nominating office that they were their number one nominee, but that senator or representative didn't actually submit the nominee as a "principal" nominee. Simply as the first on their list. That's not the same as a principal.
Principal nomination, plus 3Q equals automatic appointment. Non principal plus 3Q equals the academy's choice. Any nomination and not 3Q equals NO appointment.