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BARABOO VETERANS MEMORIAL

Baraboo School District Veterans Memorial Honor Roll
Online Application

This application requires a copy of your DD 214.

We can accept a digital version (Scan of your DD 214) uploaded below as you complete this online form.
Or you can fill out this form and send in a photocopy of your DD 214. If you send the DD 214 photocopy please send it with a printout of this webform confirmation that will come to your email and mail to:

Baraboo Veterans Honor Roll
P.O. Box 37
Baraboo, WI 53913

If you prefer to print a hard copy of this form and mail it in with a photocopy of your DD 214 - Click here

DD 214 Submission Options Using this Online form(Required)

Upload to this form

Mail DD 214 with printout of your online submission

PLEASE UPLOAD A COPY OF YOUR DD 214 OR EQUIVALENT!!(Required)

Accepted file types: jpg, gif, png, pdf, Max. file size: 30 MB.

Name(Required)

First Last

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Email(Required)

Phone(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Date of Discharge(Required)

MM slash DD slash YYYY

DID YOU ATTEND THE BARABOO SCHOOL DISTRICT?(Required)

Yes

No

It is not mandatory to have gone to school in the Baraboo School District to join us.

What Grade(s)?

Starting Grade(Required)

Last Grade Attended(Required)

WHERE WERE YOU LIVING WHEN YOU WENT ON ACTIVE DUTY?(Required)

Reason Called to Duty (Conflicts) - You many choose multiple if applicable

BERLIN CRISIS (CALLED TO ACTIVE DUTY BY EXECUTIVE ORDER 10957

LEBANON (8/1/82-8/1/84)

GRANADA (10/23/83-11/21/83)

SOMALIA (12/9/92-TBA)

LIBYA (ON 4/18/96)

RESCUE HOSTAGES - (HUMANITARIAN SERV. MEDAL)

BOSNIA (12/1/95-TBA)

KOREA (6/27/50-1/31/55)

AFGHANISTAN (10/7/01–8/30/21)

PANAMA (12/20/89-1/31/90)

PERSIAN GULF (8/1/90-TBA)

USS STARK (ON BOARD 5/17/87)

HOSTAGE IN IRAN (80/81) - (VALOR RIBBON BY STATE DEPT)

HAITI (DATES NOT SET)

VIETNAM (8/5/64-7/1/75)

Other Conflicts - Please be specific

Date(Required)

MM slash DD slash YYYY

Signature typed(Required)

First Last

Signature

You may sign online using a mouse, finger or stylus. To use your finger or mouse, your device must be a smart phone, tablet or a computer with touchscreen capability.

Consent(Required)

I agree that this digital signature verifies my consent to submit this information and donation

THE VETERAN’S SIGNATURE WILL INDICATE HER/HIS PERMISSION TO PLACE HER/HIS NAME ON THE HONOR ROLL. THIS IS REQUIRED BY THE PRIVACY ACT OF 1974

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