HOMETOWN NEWS RELEASE SURVEY

"This Survey is for USCG Personnel Only"

PRIVACY ACT STATEMENT -- AUTHORITY: 5 U.S.C. 301, and 14 U.S.C. 93f and 10 U.S.C. 8012 and 8034, and EO 9397. PRINCIPAL PURPOSE: To prepare news stories and news releases for distribution and publication by civilian news media to recognize the achievements of Coast Guard members. ROUTINE USES: Information may be disclosed to civilian news media representatives. Once published, information is considered "Public Domain." DISCLOSURE IS VOLUNTARY: Failure to provide the information may mean little or no public news release material can be produced, thus denying the individual public recognition for personal achievement. Questions should be directed to D14 Coast Guard Public Affairs at 808-535-3230.

Name: First, MI, Last
Rank/Rate:
Date entered service:
Unit name/location:
Describe your primary job at your unit.
Hometown name/state/zip:
Hometown newspaper name:
Additional towns to receive your information if any:
What would you like your hometown to know about your unit or mission?
If you were involved in a recent Coast Guard mission, received an award or are part of a newsworthy event please provide details and describe your role.
Do you have a digital camera at your unit that can be used to take a photograph of yourself to distribute to media?
Yes
No
High School -- complete name/year graduated:
College/University -- Complete name/degree/year graduated:
Mother's full name:
Father's full name:
Other relatives full name/relationship:
Phone number(s) the media can contact you at for an interview: