Biographical Data Form


Name:
 
Address:
City:  
State:  
ZIP: 

Telephone:
 Email: 

Place of Birth: 


Birth Date:  

Male __ Female __

Race/ Ethnicity (optional) 

Branch of Service 

Battalion, Regiment, Division, Etc.
 
Highest Rank 

Date(s) of Enlistment/ Service 

War(s) in which individual served 

Locations of military service 


Did the veteran sustain combat

or service related injuries? 

Was the veteran a prisoner-of-war? 

Medals or special service awards. List

Does the veteran have photographs, manuscripts, 
or field maps or war-time related home movies 
that they would like to share with the Library 
of Congress? If so, please list: