Questions About This Form? Use Email

Distinguished Service Medal
Replacement Recognition Application Form

INSTRUCTIONS:

1. Complete this form in full. ( Click here to email amerwar@amervets.com if you have any technical problems sending this Application Form after you have completed it )

2. Click the button at the bottom of this completed form to email it to The War Library, along with a copy of your or the veteran's DD-214, WD 53-55, or you can Print and mail this form and the required documents to the Library's mailing address below.

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

Service Branch

Recipient's LAST Name (as it appears on the Report of Separation):
FIRST Name (as it appears on the Report of Separation):

MIDDLE name (as it appears on the Report of Separation):
Title (Must appear on military documentation):Jr Sr II III IV

Rank Title (Please Do Not Abbreviate):

Paygrade
Enlisted
Warrant
Officer

I have not moved. My current address info is on file from a previous application

Address:
City:
State:
ZipCode:
Phone (NO SPACES OR DASHES):

Your full and complete contact email address:

SERVICE NUMBER:
(Do Not enter any alphabet letters. Numbers only.)
★ Enter the veteran's 1st FOUR DIGITS ONLY  ☛ 
★ Enter the 2nd FOUR (or remaining) DIGITS ONLY   ☛ 

Overseas Mission:

Other area:

If you are sending a Check please indicate:

  • I will mail a Check along with my application and documentation. The Library will receive my envelope within 10 days from today.

    • CHARGE or DEBIT CARD applicants:

    -- My current Card information is already on file from a previous Application

    If your Card information is not on file, please Complete the following...

    Payment Method

      Check Debit
      Visa
      MasterCard
      American Express
      Discover
      Diners Club
      Carte Blanche

    Card number:
    Expiration Date
    Card Verification Number (CVV Code) (See below)
    American Express: 4 digits on front of card
    All other cards, 3 digits on back

    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 want to purchase the Full Color...

  • PDF emailed (full color, printable) ($7.50) ( RECOMMENDED, No USPS shipping fee )
  • Document shipped ($27.43)...
       Document only with wallet card ($33.43)
  • Document shipped in Bond Enclosure ($32.43)...
       Document in Bond Enclosure with wallet card ($38.43)

    • (The shipping totals above include the USPS - Priority Mail shipping fee)

    Would you like an archive (black&white) copy of the Certificate you are applying for to be mailed from the Records Chief directly to your Commanding Officer -or- to your Employer -or- to your School Administrator for inclusion into your permanent personnel file jacket?
    (Fee: $3.50) Available only when a published certificate is requested. Not available with emailed certificates.

  • No.
  • Yes, please mail an embossed, B&W copy of my Certificate to the following person and address:


    • Official's name

    Official's Title

    Official's Agency Name (name of unit, vessel, office, school, etc.)

    Address

    City, State, Zip

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

  • No, I will obtain the free jpg copy

  • Yes, please include a Medal Will for a MALE heir of my Awards and add $4.00 to my total
  • Yes, please include a Medal Will for a FEMALE heir of my Awards and add $4.00 to my total

    • THE MEDAL, RIBBON AND LAPEL PIN

  • Because I am requesting the display recognition to be shipped to me, please include the official medal, ribbon and lapelpin for half-price.

    Add an additional $35.00 for the Air Force medal, ribbon and lapelpin to my total

    • Add an additional $35.00 for the Army medal, ribbon and lapelpin to my total
  • No, I already have the hardwear

    • Would you like to track your package through the United States Post Office after it has been shipped (for twenty [.20] cents extra)?

    • Yes, add 20 cents to my total
    • No, I don't want to track my package

    Your Application Form is now complete. After clicking the button below to send this Form you will soon receive a confirmation email containing final instructions on which items, if any, are needed to fulfill your request. Your DD-214 can be mailed or emailed. Non-personalized items such as hardwear may be exchanged or returned within ten days of delivery.

    Records Chief (REC-AMW)
    The American War Library
    817 East Via Carmelitos
    Virginia Building 319
    Long Beach CA 90805-7549
    Phone: 1-562-422-4100 (Pacific Time Zone)

LINK: Policy Statements On Display Recognitions and Hardwear
Name-personalized items that are produced uniquely for a recipient may not be exchanged or returned. However, although typographical errors are very rare, there is no time limit on requesting corrections to errors.

Print a copy for yourself before clicking the bar below..