Send Completed Applications to:

STATE VETERANS AFFAIRS; 118 State Street, Drawer 20; Montpelier, VT 05620-4401

Toll-free: (888) 666-9844; Phone: (802) 828-3379; Fax: (802) 828-5932

VETERANS MEDAL AND DISTINGUISHED SERVICE MEDAL APPLICATION

Approved applicants for these medals will receive a full-size medal, a ribbon matching the medal, a miniature lapel pin, and a certificate. Both medals share the same cast, with the Vermont Veterans Medal bronze and the Vermont Distinguished Service Medal Silver.

ELIGIBILITY

Vermont Veterans Medal

1. Must have been a Vermont resident when he/she entered military.

2. Must have an honorable discharge, unless died prior to separation.

3. If active duty service, must have served a minimum of two years, unless discharged for the convenience of the government.

4. If national guard or reserves service, must have been mobilized and brought on active duty during a period of conflict.

Vermont Distinguished Service Medal

1. Must have been a Vermont resident when he/she entered military service.

2. Must have received an honorable discharge, unless he/she died prior to military separation.

3. Must have served in a combat theater.

The Office of Veterans Affairs will review the veteran’s record to determine eligibility for one or both medals.

VETERAN INFORMATION

Name of Veteran: Social Security #: - -
Address: Phone Number:
Town: State: Zip:
Date of Birth: The Year the Veteran Entered Active Duty or Mobilized:
The Veteran is: q Living q Deceased The Year the Veteran Exited Active Duty or Demobilized:

The State of Vermont has the military discharge of most veterans who entered the military from Vermont. If we do not have a copy of the discharge to verify service, the applicant must provide proof of military service. If the military member was killed in action or is missing in action, submit a DD Form 1300 with this application.

CIRCLE DELIVERY METHOD

MAIL

This delivery method will have the medal mailed directly to the veteran or next of kin. This is the quickest method of delivery, although there is no presentation.

PRESENTATION

CEREMONY

The applicant can select to have the medal presented to the veteran or next of kin by a representative of the state in a graduation style ceremony. The veteran or next of kin will receive a letter notifying them of the date and time of the next ceremony in their region. If the veteran does not attend the ceremony, the medal will then be mailed.

APPLICANT INFORMATION (IF APPLICANT IS NOT THE VETERAN)

Name of Applicant: Address:
Address: Phone:
Town: State: Zip: Relationship to Veteran:

Relatives or friends of the veteran may apply for the medals on the veteran’s behalf. However, medals will only be mailed or presented directly to the veteran or veteran’s next of kin. Due to a limited supply, the veteran or family will be sent only one set of each medal. No medals will be sold or provided to collectors.

State of Vermont, Veterans Affairs Office Form. Printed December 1, 2003.