NMPMA, NC Triad-Triangle Chapter 38 - Congressional Gold Medal Submission

NMPMA CONGRESSIONAL GOLD MEDAL (CGM)

Info & Documentation Submission Form
This is the NMPMA internal form used for submitting CGM applicant information and supporting documentation to the National President & staff for review and approval consideration.

*This form routes to the National Secretary, National VP, & the National President.
CGM APPLICANT INFO
Name of CGM Applicant*

First NameMiddle Name (optional)Last NameSuffix
Life Status*

LivingDeceased
Home of Record

Street Address

Street Address Line 2

CityState

Zip Code
Date of Birth (DOB)*

DayMonthYear
Date
Date of Death (DOD)

DayMonthYear
Date
Service Entry Date*

DayMonthYear
Date
Service Discharge Date*

DayMonthYear
Date
Service Discharge Rank
Applicant's Service #*
Document(s) Upload*

Browse Files
EX: Service Discharge, doc(s), DD-214, Montford Point Muster Roll, etc. Cancelof
CLICK HERE to redirect to the National Archives to request military records for Veterans.
NEXT OF KIN (NOK) POC INFO
NOK POC Name*

First NameMiddle Name (optional)Last NameSuffix
Relationship to CGM Applicant
Street Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email Address*
example@example.com
SUBMISSION INFO

NMPMA SUBMISSION POC - CHAPTER - REGION INFO
Submitter's Name

First NameLast Name
Submitter's Chapter*
NMPMA Region
Additional info/comments about this CGM submission:
Should be Empty:

NMPMA CONGRESSIONAL GOLD MEDAL (CGM)