Memorialization Request for Service Member on Fountain Square Memorial Wall
Name of Requestor
Service Member Name
Did the service member die prior to January 1, 2003?
Did the service member die in a:
The service member lived in the City of Evanston for at least five (5) years.
The service member listed the City of Evanston as his/her home of record on his/her commissioning or enlisted documents.
The service member's parents or guardians have lived in the City of Evanston for at least ten (10) years, and the service member lived in Evanston during some part of his/her life before making the ultimate sacrifice for his /her country.
Provide a brief summary of the service member's duty history.
Send me a copy of my responses.
Never submit passwords through Google Forms.
This form was created inside of CITY OF EVANSTON.