Military Memories Questionnaire
The Museum of Wayne County History is interested in documenting the names and dates of service for as many local veterans and service men and women as possible, but more importantly, documenting in some way their unique stories. As the respondent, please take some time to fill out this questionnaire for one Service Member at a time. We will review the information, save it to our digital archives, and include it in our Military Memories exhibit that will be open at the Museum from May through November. We will contact you to let you know we received your submission. You can contact us anytime at 315-946-4943 or email  info@WayneHistory.org. 
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Email *
RESPONDENT INFORMATION
Thank you so much for taking the time to share your Military Memories in this questionnaire. We need your contact information so that we can follow up with you and to be sure we document your Service Member's memory accurately. We will be adding this information to our Military Memories Exhibit throughout the year. Feel free to share this form with others. Once you submit this form, you will receive a copy of your answers to the email address you entered above. 

The Respondent can also be the Service Member. NOTE: We will refer to all military members as Service Members. 
Respondent's Full Name *
Respondent's Phone Number *
Respondents Relationship to Service Member? (i.e. Self, Son, Granddaughter, not related, etc.) *
SERVICE MEMBER INFORMATION
Please provide some basic information about each veteran or active military person you wish to submit. You will be prompted to fill out another form after you submit this one.  

County Service Members can be submitted from any time period ranging from pre-revolutionary French-Indian War to current military intervention. We are interested in service members who at some time in their life called Wayne County their home, whether at birth, in youth or adulthood, even if for a short time. We will ask for digital copies of documents of proof of service for ancestors, living veterans, and active military service, but it is optional. We will also be asking for contact information for the person filling out this questionnaire. 
Service Member's Full Name  *
Service Member's Last Name (Maiden/Nee, if applicable)  *
Service Member's Middle Initial (if known)
Enlisted name, if different
Date or approximate Year of Birth (if known)
Place of Birth (Town, City, State), if known. 
WAYNE COUNTY RESIDENCY: When (approximate time span) was the Service Member a resident of Wayne County? For example, 1860's or exact dates such as 1953-1993.
*
Primary Town(s) where Service Member lived in Wayne County. 
*
Required
Branch of Service
*
Start Date (or approximate year) of Enlistment or Draft Service.
*
If known, enter location of Basic Training or Military Academy.
Military Occupational Specialty School (MOS), if known, or general assignment.
Initial Duty Assignment (Facility, Town, State, Country), if known.
Major Division or Unit/Ship Assignment, if known
Other Active Duty Service (Location), if known
If Service Member was active during a War, Conflict or Intervention, please indicate which one(s). (NOTE: This list is not exhaustive. Choose Other and see next question to write in your response.)
*
Required
If you chose Other from above Question regarding War or Conflict Service Member served, please write in your response. 
Highest Rank Achieved, if known.
Decorations (Other response, see write in following Awards)
Awards  (Other response, see write in following Awards)
If you answered "Other" to Decorations or Awards, please write in explanation here. 
Was injury sustained?
Clear selection
If injured during service, please explain. 
Discharge status?
*
Date of Discharge or approximate year, if known.
If applicable, Burial Location? (if applicable)
Please consider telling us of any personal memory you would like to share about the Service Member's experience. (If more space is needed or you have documents to share, please briefly explain here and check YES to the next question. We will contact you.)
If you have any photos, documents or artifacts pertaining to the Service Member that you would like to loan, donate, or offer as digital file (photo, scan of document, etc.) for our Military Memories exhibit and archive, please check YES, and items that apply then we will contact you via email or phone.  
The Wayne County Historical Society produces an audio podcast called Unlock Wayne County. If you or your service member are interested in sharing your Military Memories in this conversational podcast, please mark YES below. We will contact you to discuss. 
A copy of your responses will be emailed to the address you provided.
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