Phone/Fax: 1-310-532-0634

    Civilian Service
    Recognition Application Form

    INSTRUCTIONS:

1. Complete this form in full.
2. Print and mail or fax this completed form, along with a copy of your DD-214, WD 53-55, or other pre-arranged military document(s) to the address below.

Do Not Hilite, Underline, Circle, Colorize
Or Mark In Any Way The DD-214
Or Other Military Document Photocopy
You Will Mail.

    Charge card or Debit card applicants: To expedite shipment of your Recognition you may email this form today. Your Recognition will be prepared and awaiting the arrival of your DD-214 or other, pre-arranged military document(s).

    Type of Award:

    Recipient's LAST Name:
    FIRST Name:
    MIDDLE name:
    Title (Must appear on military documentation):Jr Sr II III IV

    Street Address:

    City:
    State:
    ZipCode:
    Phone:

    Your full and complete email address:

    Military Base Where Awarded:

    Date of Award:

    If you are sending a check or Money Order please indicate:

    • I will mail a check along with my application and documentation

    • I will mail a money order along with my application and documentation

    Charge or Debit Card applicants, please complete the following:

    Your Name as it appears on your charge or check debit card:

    Payment Method
      Check Debit
      Visa
      MasterCard
      American Express
      Diners Club
      Carte Blanche

    Card number:
    Expiration Date

    After printing this form for mailing, please sign here:

    International shipping cost (U.S. veteran living outside the United States, please add the shipping cost you were quoted...

    TOTAL ADMIN PROCESSING/DELIVERY:

  • I would like the following Display Recognition...
  • .PDF Emailed - $9.50 Black & White (No Color)
  • U.S. delivery - $21.20 Full Color Document Only
  • U.S. delivery - $25.70 Full Color Document in Bond Enclosure
  • Would you like the full-color Wallet Size Certificate along with one of the above full-size color Certificates ($3.50) Yes No
  • I do not want the Display Recognition. I am requesting the hardware items listed below (medal, badge, ribbon or patch) if they are available for this award. (Shipping cost applies to non-certificate requests.)

    Would you like to receive the Official, full size Commander's Award for Civilian Service replacement medal?

  • Yes, please include the official medal and add an additional $12.50 to my total.
  • No, I already have the hardware.

    • Would you like to receive the Official, full size Commander's Award for Public Service replacement medal?

  • Yes, please include the official medal and add an additional $12.50 to my total.
  • No, I already have the hardware.

    • Would you like to receive the Official, full size Achievement Medal for Civilian Service replacement medal?

  • Yes, please include the official medal and add an additional $18.50 to my total.
  • No, I already have the hardware.

    • Would you like to receive the Official, full size Meritorious Civilian Service replacement medal?

  • Yes, please include the official medal and add an additional $12.50 to my total.
  • No, I already have the hardware.

    • Would you like a published copy of My Military Medal Last Will And Testament?

  • Yes, please include a Medal Will for a male heir of my medals and add $4.00 to my total

  • Yes, please include a Medal Will for a female heir of my medals and add $4.00 to my total

  • No, I will obtain the free jpg copy

    • Would you like to track your package using the internet through the United States Post Office after it has been shipped (for seventy [.70] cents extra)?

  • Yes, add 70 cents to my total

  • No, I don't want to track my package

    • Click Here if you are a Prior Applicant who's DD-214 is on file
    New Applicants Click Here

    Your Application Form is now complete. Print, Sign and Mail this completed form to the address below along with the required military-issued Report of Separation or other (pre-approved) document(s). You may (OPTIONAL) email this form for faster processing. However, you must still mail or fax a copy of your military document(s).

Records Chief (REC-AMW)
The American War Library
Building Two, 16907 Brighton Avenue
Gardena CA 90247-5420
Phone/Fax: 1 310 532 0634