Vietnam War Veterans Questionnaire
Please answer the questions below and return to Michael Rothfeld, 4905 Los Altos Circle, Elkton, FL 32033, H 904-829-0381, C 904-502-7154, or to carocats@bellsouth.net
The questionnaire will be used to select interviewees for a Vietnam War documentary that is in the planning stages.
Name: ____________________________________________________
Address:_________________________________________________Phone:__________________________
Branch of Service: __________________________ Years of Service: 19_____ to 19 _____
Highest Rank Achieved: __________________________ Enlisted _______ Drafted ________
Battalion, Regiment, Division, Unit, Ship, etc.
Did you receive any Medals, Citations, and Commendations? Yes ____ No ____
If yes, please list them below.
Were you in combat? Yes ____ No ____, If yes please list battles fought in, were you wounded & did you receive the Purple Heart. If not where were you stationed and what did you do. (use the back of the page if you need more space)
Did you sustain combat or service related injuries? Yes ____ No ____
Do you have any interesting war stories to tell? You may use the other side of this paper if you need more space.
Do you have any pictures or memorabilia that we may use? Yes ___ No ____
How were you treated when you returned from the war? (please use other side of page if you need more space)
If you are chosen for the documentary, a copy of your DD 214 may be needed to verify your information.