Deceased Veteran and Surviving Family Member or Relative
Email address *
Submitter First Name *
Phone *
999-999-9999
Submitter Last Name *
Attending *
If the bill is passed, a ceremony will be in Washington, D.C.
Relative *
Veterans First Name *
Congressional Medal *
Honorably at any time during the period beginning July 26, 1941, and ending December 31, 1946; (2) in an active-duty status under the command of the United States Armed Forces in Far East; and (3)(A) within the Philippine Commonwealth Army, the Philippine Scouts, the Philippine Constabulary, Recognized Guerrilla units, the New Philippine Scouts, the First Filipino Infantry Regiment, the Second Filipino Infantry Battalion (Separate), or the First Reconnaissance Battalion;
Veterans Last Name *
Branch of Service *
Unit Specific Name or Specific *
(Batangas FAIT, or 57th In Regt PS)
Submitted name to National? *
Say “No” until your Region Chair has confirmed it is submitted
Home Address *
Apt#
City *
State *
(abbreviation)
Zip Code
Country *
Have you emailed or mailed evidence to fanhshtx@gmail.com or 1802 Ridgewood, Houston, TX 77006?
Evidence can be a photo in uniform, orders, service number
Please describe evidence of service for named veteran.
Upload any attachments as evidence of service based on the Filipino WWII Congressional Gold Medal requirements.
Privacy Statement: By completing this form you consent that information you provide will be used for the purpose of requesting a copy of the Congressional Gold Medal for your requested family member. If you are successful you will be contacted on the next steps.
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