JAPANESE AMERICAN
NATIONAL MUSEUM

100 North Central Avenue
Los Angeles, CA 90012
Telephone: 213.625.0414
Facsimile: 213.625.1770

Dear Friend and Veteran:
The Japanese American National Museum invites you to become part of our national database on
Japanese Americans who have served in America’s military. This is a unique and ambitious
project based on the personal input of people like you who have served or are currently serving
in the military.
We encourage you to please answer the accompanying questionnaire. Your information is vitalin helping the National Museum create this educational resource. Your participation also
provides a way to document your life experience along with the thousands of other JapaneseAmericans who served in the military during peacetime or war.
Please answer the questionnaire to the best of your ability – there are no right or wrong answers.
We would simply like to document, through your own words, your experiences during this key
portion of your life. Your answers may be as long or brief as you wish. The more information
you can provide, the richer your military biography will be.
If you feel comfortable doing so, we ask that you also loan us a photograph of yourself during
the time you served in the military. We will return your photograph after scanning it. If you do
not have a photo of yourself in uniform, a photo of yourself around the time you were in military
service will be fine.
Your survey data will be processed within the Hirasaki National Resource Center by Museum
personnel. Your mailing address and phone number are kept confidential and only the survey
data will be available to the public. We ask that the enclosed “Deed of Gift” release form becompleted to allow public disclosure of your survey. Your completed questionnaire, photographand “Deed of Gift” form should be returned to:Japanese American National Museum
100 North Central Avenue
Los Angeles, CA 90012
Attn. Hirasaki National Resource CenterOnce your survey has been added to our database, a printed copy of your information will bemailed to you along with any photographs you may have sent us. Thank you in advance for yourvalued participation; it is an important contribution to the National Museum and its mission. If
you have any questions, feel free to call us at 213-830-5680.
Sincerely,Hirasaki National Resource Center100 North Central Avenue
Los Angeles, CA 90012
Telephone: 213.625.0414
Facsimile: 213.625.1770

JAPANESE AMERICAN
NATIONAL MUSEUM

LIFE HISTORY/QUESTIONNAIRE
DEED OF GIFT
I,, residing atin the City ofCounty of, State of, hereby

consent to the use of the life history/questionnaire and/or photographs that I have submitted to theJapanese American National Museum, (the “Museum”). It is my intention to make mywritten/typed responses and photographs gifts to the Museum. I understand that the Museum will
use my written/typed responses and photographs for historical, scholarly, and Museum exhibitionand promotional purposes as they see fit.
I hereby give consent to the Japanese American National Museum to use these gifts in the manner
described herein.
Donor - Print Name

Donor - Signature
DateI,, as the duly appointed representative of the JapaneseAmerican National Museum, accept the written/typed responses and/or photographs fromfor inclusion in the Japanese American National Museum
collection.
Museum Representative – Print Name
Museum Representative – Signature
Dated

JAPANESE AMERICAN MILITARY SERVICE QUESTIONNAIRE
The Japanese American National Museum is creating a database on the Japanese Americans who
have served in America’s military. The information you provide is vital in helping the Museum
create educational materials which can be shared with its visitors. Your participation also
provides a way to document this portion of your life experience with the thousands of otherJapanese Americans who served in the military during peacetime or at war.
NameAddress
City, State, Zip
Daytime Phone: ()Evening Phone: ()PLEASE PRINT OR WRITE ALL RESPONSES NEATLY to minimize the possibility of errorsin transcription. Please print names, places and other items that are unusual or might easily bemisread. If you need additional space to answer any question, use the back of the page or use
additional page(s). Indicate the number of the question on these additions. We also would
greatly appreciate it if you could include a photograph of yourself during the time you served in
the military. If you do not have a photo of yourself in uniform, any photo of yourself around thetime you were in service will be fine.

COMPLETED QUESTIONNAIRES together with, if possible, your photograph to be returnedto:
Japanese American National Museum
100 North Central Avenue
Los Angeles, CA 90012
Attn. Hirasaki National Resource Center
For further information or clarification, please call 213.830.5680.

Background Information
1. Name(Last
2.

MaleFirstMiddle)(Nickname)Coast Guard

Air Force

Female3. Date of birth

Birthplace

4. Place and date of induction:
5. Check:

Army

Navy

MarineOther, please specify:
6. Rank, highest achieved
7. Military Occupation Specialty

8. Unit(s) served in:

9. Date and place of separation:
10. (Check each appropriate item)
Peacetime

WarVolunteer

DrafteeCombat

SupportYour Military Experience
11. Countries you were stationed in, including stateside sites

12. My unit’s responsibility was

13. My personal responsibility was14. If you served in a war zone, what major battles did you participate in?

15. Awards, medals, citations, etc. you or your unit were awarded (list and give a brief
description for what you or your unit did to win that particular award.) Use the back of thispage if necessary.

16. Describe your living conditions – Where did you sleep? How did you bathe? What weremeals like? What did you do for entertainment?

17. What is the most vivid memory (humorous, serious or whatever else significant) of yourmilitary experience?

18. What did you miss the most while you were in the military?

19. What do you feel has been the most important thing to you personally to come out of yourmilitary experience? What would you like your family and those close to you to know andunderstand?

20. Please include any other information about yourself that you feel is pertinent. If you needmore space, use the back of this page or include additional pages.