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Veteran Information Form

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Please correct the field(s) marked in red below:

Please complete this online form for yourself or a military Veteran you want recognized in the City of Victorville's Veterans Day Ceremony.  Information you provide will be used to honor your Veteran in a tribute video that will be shown during the Ceremony on Nov. 11.  We will also include information about your Veteran and a picture in the printed event program that will be distributed at the Ceremony.  The tribute video will be shared to our website, Facebook and Instagram pages after the event.

 

We are requesting Veteran photos to help us personalize the video.  Instructions for submitting photos will be provided on Page 4.  This form must be submitted no later than: Oct. 22. 

 

While we will pay tribute to all Veterans during our celebration, the Salute to Victorville Veterans will give individual recognition to military Veterans who have lived in Victorville at some point in their lives.

 

For questions about the form below, please contact Public Information Officer, Sue Jones by phone at (760) 955-5028 or by email at VictorvilleVeteran@Victorvilleca.gov.

1
INFORMATION ABOUT THE VETERAN
 *
2
Highest Rank Earned/Current Rank
 *
3
Branch of Service (Please select all that apply.)
 *
Branch of Service (Please select all that apply.)
4
Military Occupational Specialty or Code or job function, if known (ie. Infantry, Combat Medic, Pilot, Mechanic, etc.)
5
Service
Service
6
Date entered service (You can give an approximation, ie. April 1945, 1945 or Spring 1945)
 *
7
Date ended service (If Veteran is still serving, answer "presently serving.")
 *
8
Did the Veteran retire from military service
 *
Did the Veteran retire from military service