BIOGRAPHICAL DATA FORM
To ensure inclusion in the Veterans History Project, this form must accompany each submission. Please use additional sheet if service was in more then one war or conflict.

PLEASE PRINT CLEARLY
Veteran __ Civilian ___ __________________________________________________________________________
FIRST MIDDLE LAST MAIDEN NAME
Address ______________________________________________________________________________________
City ______________________________ State ___________ Zip ________________________________________
Telephone ( )____________________ Email ________________________________________________________
Place of Birth ____________________________________ Birth Date _____________________________________
Race/Ethnicity (optional) _____________________________________________________ Male ____ Female ____
Brach of Service or Wartime Activity ________________________________________________________________
Commissioned ____ Enlisted ____ Drafted ____ Service Dates _____________________ to ___________________
Highest Rank __________________________________________________________________________________
Unit, Division, Battalion, Group, Ship, etc . (Do not abbreviate) ____________________________________________
_____________________________________________________________________________________________
War, operation, or conflict served in _________________________________________________________________
Locations of military or civilian service _______________________________________________________________
_____________________________________________________________________________________________
Battles/campaigns (please name) __________________________________________________________________
_____________________________________________________________________________________________
Medals or special service awards. If so, please list (be as specific as possible): ______________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
Special duties/highlights/achievements ______________________________________________________________
_____________________________________________________________________________________________
Was the veteran a prisoner of war? _________ Yes __________ No
Did the veteran or civilian sustain combat or service-related injuries? __________ Yes _____________ No
Interviewer: