Phone: 1-562-422-4100 (Pacific Time Zone)
Email Questions

Officer Candidate Display Recognition Application Form

INSTRUCTIONS:

    1. Complete this form in full.
    2. Print and mail this completed form, along with a photocopy of the required document(s) described on the Information Page, or other pre-arranged 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 Replacement Recognition you may email this form today. Your Replacement Recognition will be prepared and awaiting the arrival of your DD-214 or other, pre-arranged military document(s).

    I am requesting the...


    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):

    Street Address:

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

    Full and complete contact email address:

    Recipient's Service Number:

    What was your GT (General Testing) score?

    What was the name of military base where you took your entry examinations:

    What was the date (or year) you took your entry examinations:


    Complete this section if you graduated OCS...

    Name of Military Installation where OCS was attended:

    What was/is your MOS (Military Occupation Specialty):

    Date you graduated OCS:

    Your rank at graduation:


    If you are sending a check or USPS money order please indicate:

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

    • I will mail a USPS 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
      Discover
      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:

  • .PDF Emailed - $7.50 Full Color
  • U.S. delivery - $21.15 Full Color Document Only
  • U.S. delivery - $27.45 Full Color Document in Bond Enclosure
  • U.S. delivery - $7.50 Full Color printable PDF Document on CD-Rom (when requesting a minimum of 25 certificates). $8.45 USPS shipping added to total
  • I do not want the Display Recognition. I am requesting the hardwear 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 the full-color Wallet-Size Card Certificate along with one of the above full-size color Certificates (Wallet Cards are available only when a paper-published Certificate (not emailed Certificate) has been requested.)
    Yes, Unlaminated ($3.50)
    Yes, Laminated ($6.00)
    No

    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)

  • 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

  • Would you like to track your package through the United States Post Office after it has been shipped (for seventy-five [.75] cents extra)?

  • Yes, add 75 cents to my total
  • No, I don't want to track my package

  • Ignore this final Question if you will EMAIL or have previously EMAILED a copy your DD-214...

    Would you like your mailed DD-214 scanned by The War Library and integrated into your 201A Award Report that will be emailed to you when your requested item(s) are sent to you? The scanning fee is $3.00 (a one-time fee)

  • Yes, add a one-time $3.00 to my total to Scan and Integrate my DD-214 into my Award Report

  • No, I will accept my Award Report without my DD-214 appearing in the Report


  • Your Application Form is now complete. After clicking the grey-bar 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).

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)

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