BIOGRAPHICAL DATA FORM

Everyone who records interviews in connection with the Veterans History Project must fill out this form to ensure that interviewed veterans and civilians appear on the national registry honoring their service and participation. (Please print clearly)

Name of Veteran/Civilian:

______________________________________ Birth Date ____________

Address______________________________________________

_____________________________________________________

City_________________State________ZIP___________ - ______

Telephone (_____)-_______________ E-mail___________________________

Place of Birth_____________________________________________________

Branch of Service or Wartime Activity______________________________

Battalion, Regiment, Division, etc.________________________________

Highest Rank_______________________Serial#_______________(optional)

Date(s) of Enlistment/Service___________to__________ Age______

War(s) in which individual served__________________________________

Locations of service_______________________________________________

___________________________________________________________________
Did the veteran sustain combat injuries? Yes____ No_____
Did the veteran receive any medals or special service awards? If so, please list

___________________________________________________________________

___________________________________________________________________

Are photographs included? No ____ Yes ______ (If yes, please use photograph log in this kit)
Does the veteran or civilian have maps and charts that he or she would like to share with the Library of Congress? Yes ______ (If yes, we will contact you shortly.) No______
Does the veteran have wartime related home movies that he or she would like to share with the Library of Congress? Yes ______ (If yes, we will contact you shortly.) No______
Other pertinent information (optional):