Name

Class

Cullum #

1. LIFE BEFORE WEST POINT

a. Date of Birth

Place of Birth

b. Family background (military connection and/or lifestyle that helped prepare you for West Point)
 
 

c. High School

City & State

d. Prior College

City & State

e. Why did you want to attend West Point?
 
 

2. CADET LIFE

a. Special achievements or incidents as a cadet that tell more about you as a person
 
 

b. What significant values, experiences, or instruction were carried over to your life after graduation?
 
 

3. ACTIVE DUTY PERIOD

a. Branch

Assignments
(If answer to b. below is yes, disregard.)
 
 

b. Is Register info current and complete?  Yes   No
If no, the following should be added:
 
 

c. Significant assignments and achievements
 
 

d. Date you left military service

Did you retire?  Yes   No
Place of retirement

4. CIVILIAN EMPLOYMENT (after military service)

a. Career Field(s)
 
 

b. Post Graduate Schools attended, degrees attained
 
 

c. Position(s) held, significant achievement(s)
 
 

d. Date you left civilian employment

Did you retire?  Yes   No

e. Current address (City & State)

5. FAMILY LIFE

a. Date and place of marriage

b. Name of Spouse

Names of Children
 
 

c. Children attending/attended West Point (names and class year)
 
 

6. LIFE AFTER RETIREMENT

a. Interests, hobbies, pursuits, and accomplishments

b. Reflection on your life, you as a person as you want to be remembered
 
 

 
 

7. FAMILY MEMBERS, CLASSMATES, OR FRIENDS who would be the best source of information about you and your life
 
 

8. PHOTO ENCLOSED  Yes  
 
Use Howitzer photo  Yes   No

9. ADDITIONAL COMMENTS not covered above