Veteran & Military History Education Program - Information Form

We invite you to participate in the Stamford Veterans Park Partnership Veteran & Military History Education Program. The following questions are designed to help document your service or your family member's service to our country. Your participation will help educate others about veteran history and highlight the sacrifices made by the men and women who fought for our freedom. This collection of information will be placed on our website through our veteran and military education program and featured in our education highlights.

We realize that all of the information requested below may not be available to you or may not be applicable to you -- complete what information you have and would like to share.

We also recognize our form may not allow for space to include additional information you may wish to share. Should there be additional information, photos, or documents you would like to include, please use the upload feature for your files at the bottom of the form.

Once your information is received and transferred into our presentation format, we will provide a final copy for your review before posting. Thank you for your service, sacrifice, and willingness to be part of this program.

If you have any questions or would like more information about this program, please contact Colleen Harkey, SVPP Executive Director at harkeyvppartnership@gmail.com - or - 203-803-9086.

Contact Information

Veteran's Name

Prefix

First Name

Last Name

Suffix

Name of Person Completing This Form (if not the same as above)

Prefix

First Name

Last Name

Suffix

Verify Email

Phone

Address

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Country

Number of Years Living in Stamford -- Dates if available.

This is an open text box - any details about the veteran's life in Stamford may be included here.

Date of Birth:

Date of Passing - if applicable:

Branch of Service

Select more than one if you served in more than one branch of service.

U.S. Army

U.S. Navy

U.S. Marine Corps

U.S. Air Force

U.S. Coast Guard

Age when you entered into service:

How old were you when you began your service. Did you enlist / were drafted -- was it out of high school or after college?

How many years did you serve?

Rank:

Theatre of Service / Where you were stationed:

This is an open text box.

Decorations / Awards / Ribbons / Other recognitions

If you received a Purple Heart, please note the information at the end of this form regarding Stamford as a Purple Heart City.

Congressional Medal of Honor

Distinguished Service Cross

Air Force Cross

Navy Cross

Silver Star

Bronze Star

Purple Heart

Award / Decoration / Ribbon / Other Recognition:

Date received if available.

(mm/dd/yyyy)

Award / Decoration / Ribbon / Other Recognition:

Date received if available.

(mm/dd/yyyy)

Award / Decoration / Ribbon / Other Recognition:

Date received if available.

(mm/dd/yyyy)

Award / Decoration / Ribbon / Other Recognition:

Date received if available.

(mm/dd/yyyy)

Recollections / Stories of Note:

This is an open text box to share recollections / stories of veteran service.

Supporting Documents / Photos / Articles - Up to 3 items can be uploaded here:

OTHER INFORMATION YOU WANT TO SHARE:

This is an open text box - Use this space to include any additional information you want to share or to ask questions to which you would like a response.

STAMFORD - A PURPLE HEART CITY

If you received a Purple Heart and would like your informaiton shared with the Stamford Veterans Council, please indicate your approval by selecting "yes" below.

Purple Heart Recipients:

If you do not select either box, your information will not be shared.

Yes, I received a Purple Heart - please share my information with the Veterans Council of Stamford.

No, do not share my information.