REQUIRED
To ensure inclusion in the Veterans History Project, this form must accompany each submission. Please use
reverse or additional sheet if service was in more than one war or conflict.
Veteran Civilian
Name __________________________________________________________________________________
Address _________________________________________________________________________________
City _________________________________________ State _________ Zip _____________ – _________
Telephone (______) __________________________ Email ________________________________
Place of Birth ____________________________ Birth Date ___ /___ /_____ Death Date ___ /___ /_____
Next of Kin: Name and Address: ____________________________________________________________
Race/Ethnicity (optional) ________________________________________________ Male Female
Though you are not required to do so, providing this information will help researchers and ensure our
collections accurately reflect the races and ethnicities of all who served.
Branch of Service or Wartime Actvity ________________________________________________________
Commissioned
Enlisted
Drafted
Service dates ___ /___ /_____ to ___ /___ /______
Highest Rank_____________________________________________________________________________
Unit, Division, Battalion, Group, Ship, etc. (Do not abbreviate.) __________________________________
________________________________________________________________________________________
War, operation or conflict __________________________________________________________________
Locations of military service ________________________________________________________________
________________________________________________________________________________________
Battles/campaigns (Names) _________________________________________________________________
________________________________________________________________________________________
Medals or service awards (Please list as specifically as possible.) ____________________________________
________________________________________________________________________________________
Special duties/highlights/achievements ________________________________________________________
________________________________________________________________________________________
Was the veteran a prisoner of war? Yes No
Did the veteran sustain combat or service-related injuries? Yes No
Interviewer (if applicable) ____________________________________________________________
(Please use next page for any additional biographical information.)
VETERANS HISTORY PROJECT
Field Kit 5