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1
Applicant Information
2
Spouse Information
3
Person Legally Responsible for These Arrangements
4
Documents
Veteran Applicant
1. First Name
2. Middle Name (or Initial)
3. Last Name
4. Suffix
5. Date of Birth
5. Place of Birth
6. Social Security Number
7. Marital Status
MARRIED
NEVER MARRIED
SEPARATED
DIVORCED
WIDOWED
8. Gender
MALE
FEMALE
9. Military Status
ACTIVE DUTY
NATIONAL GUARD
RESERVE
RETIRED
VETERAN
10. Branch of Service
AIR FORCE
ARMY
COAST GUARD
MARINE CORPS
NAVY
SPACE FORCE
OTHER
11. War Service
AFGHANISTAN
IRAQ
KOREA
PEACETIME
PERSIAN GULF
VIETNAM
WWII
OTHER
12. Service Number
13. Highest Rank Attained
14. Last Name on DD-214
If different than above Last Name
PERIOD(S) of Active Duty Military Service or National Guard/Reserve Service
15a. Entry Date
15b. Entry Place
16. If Retired Military (Active or Reserve) Date of Retirement
15c. Discharge Date
15d. Discharge Place
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