Service Member Discharge Information Request Form
Please complete this form to request discharge information for a service member. All fields are designed to protect privacy and only request information necessary to process your request.
Your Full Name
*
First Name
Last Name
Your Email Address
*
example@example.com
Your Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Relationship to Service Member
*
Please Select
Self
Family Member
Legal Representative
Military Official
Other
Service Member's Full Name
*
First Name
Last Name
Branch of Service
*
Please Select
Army
Navy
Air Force
Marine Corps
Coast Guard
Space Force
Other
Dates of Service (Approximate)
Type of Discharge (if known)
Please Select
Honorable
General (Under Honorable Conditions)
Other Than Honorable
Bad Conduct
Dishonorable
Unknown
Last 4 Digits of Service Member’s Reference Number (e.g., SSN, Service Number, etc.)
*
Reason for Request
*
Please Select
Personal Records
Benefits Application
Legal Purposes
Genealogy/Family Research
Other
Preferred Delivery Method
*
Email
Postal Mail
Additional Comments or Details
Submit Request
Should be Empty: