Guam Veteran Registry Form

Guam Veteran Registry

TO CARE FOR HIM WHO SHALL HAVE BORNE THE BATTLE, AND FOR HIS WIDOW AND ORPHAN. - Abraham Lincoln
have you registered with the guam office of veteran affairs before?
If you have registered previously, the purpose of this application is to update the information, Guam Office of Veteran Affairs has on your file. Please fill out as much information as possible.
Name

Last Name First & Middle Name
date of birth

MonthDayYear
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Is Your Mailing Address the same as your Physical Address?
Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
Home Number

Area CodePhone Number
Alternate Number

Area CodePhone Number
branch of service

Other
Current STATUS
Service Period (Please Select all that apply)

Other
Do you have a DD214 or Discharge Documents?
Upload your DD214 or Discharge Documents (You can also come into the Guam Veteran Affairs office to scan your dd214 and upload your document)

Upload a File

Cancelof
Would you like to know more about VA Benefits, Services or Programs?

Click the information you would like sent to you. Guam Veteran Affairs Staff will be answering any questions or responding to your inquiries in the order to which they are received. Please be sure to include an email address or mailing address to ensure a place for information to be sent.
Select all the pertain to your request

Other
Signature Date

MonthDayYear
The information submitted in this application is confidential and shall not be viewed or shared with outside parties aside from Guam Veteran Affairs Office. All information is collected, recorded and protected by the Guam Veteran Affairs Office for the purpose of creating the "GUAM VETERANS REGISTRY," WHICH SHALL BE UTILIZED FOR ENUMERATING THE POPULATION OF VETERANS ON GUAM, AND FOR THE USE OF SUCH INFORMATION FOR INCREASING OR ACQUIRING NECESSARY HEALTH CARE AND OTHER RELEVANT SERVICES TO BENEFlT VETERANS AND THEIR FAMILIES," Ref. Guam Public Law 32-101
Should be Empty:

Guam Veteran Registry

Would you like to know more about VA Benefits, Services or Programs?