Veterans Form
TOWN OF BROOKHAVEN
War Service Record of Longwood CSD Veterans
The Wars on Terror: Gulf War /Afghanistan / Iraq
Operation Desert Storm, Operation Enduring Freedom and Operation Iraqi Freedom
Please mail completed forms to: Mr. Victor Massian, Longwood JHS, 198 Longwood Road, Middle Island, NY 11953
Full Name ____________________________________________________________________________
(Please print) Last First Middle
Date and Place of Birth ___________________________________________________________________
Address at time of entrance into service_______________________________________________________
Current Contact Info (if different from above)__________________________________________________
*E-mail_____________________________ *Phone/Cell __________________________(*will not be shared)
Name of Father ___________________________ Maiden Name of Mother _________________________
Pre-Service Employment/Trade/Occupation ___________________________________________________
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Names of Schools Attended:
_____ Years at _______________ Elementary School; _____ Years at _______________ Middle School;
_____ Years at _______________ Junior High School; _____ Years at _______________ High School;
_____Years at ______________________ College; _____ Years at ____________________ Other
High school sports/activities/accomplishments ____________________________________________________
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Date and place of Induction _______________________________________ Military Branch_____________
Date and place of Separation ______________________________________________________________
Military or Naval training, occupation, qualifications, etc. _______________________________________
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Regiment, Company, Battalion Group, Squadron, etc. __________________________________________
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Ranks/Promotions__________________________________________________________________________
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Left Cont’l U.S. (Date) ________ From ________ on (boat)___________ Arrived at (place) ___________
Other Postings, Sailings: Give dates, ships, places___________________________________
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Final Arrival U.S. (Date)_______ from (place)_______ on (ship) __________ At (place) ______________
List or Describe: Army, M.C. Air Force, Navy or C.G. Service: Stations, Engagements, Campaigns, Theatres of Operation, Vessels Served On, Aircraft Flown, Commanders Served Under, Enemy Encounters, etc.
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Decorations, Citations, Ribbons, etc. _______________________________________________________
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Other information (marriage, children, post-service occupations, etc.) ____________________________
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Photograph(s) of Veteran included ____________ Will be returned
Please feel free to add any additional information you would like included in your Veterans Biography.
For more information or questions please contact pinfranco@longwoodcsd.com