CTMD Form 6-2 "Long Service Medal Application" - Connecticut

What Is CTMD Form 6-2?

This is a legal form that was released by the Connecticut Military Department - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on August 1, 2010;
  • The latest edition provided by the Connecticut Military Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of CTMD Form 6-2 by clicking the link below or browse more documents and templates provided by the Connecticut Military Department.

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Download CTMD Form 6-2 "Long Service Medal Application" - Connecticut

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CTMD Form 6-2
(Rev. 8/2010)
CONNECTICUT MILITARY DEPARTMENT
LONG SERVICE MEDAL APPLICATION
PURPOSE: To determine eligibility for the Connecticut Long Service Medal
AUTHORITY: Connecticut General Statutes Section 27-71 & CTNG Regulation 672-1
INSTRUCTIONS: Awarded to any member of the Armed Forces of the State of Connecticut who has completed ten (10)
cumulative years of state or federal military service, and for each additional five (5) years of state or federal military
service. The personnel section will complete the application form and verify the state military service. State military
service includes:
Service in the Connecticut National Guard
Service in the Connecticut State Guard
Service in the Governor’s Guards
Service on the Governor’s Military Staff
Service in any of the branches of the United States Armed Forces
The Commander of the unit will sign the document, certifying that the individual is eligible for the award.
The unit will forward the following:
Connecticut Military Department
Military Administrative Officer
360 Broad Street Room #113
Hartford, Connecticut, 06105-3706
(860) 493-2721 (fax)
Page 1 of 2
CTMD Form 6-2
(Rev. 8/2010)
CONNECTICUT MILITARY DEPARTMENT
LONG SERVICE MEDAL APPLICATION
PURPOSE: To determine eligibility for the Connecticut Long Service Medal
AUTHORITY: Connecticut General Statutes Section 27-71 & CTNG Regulation 672-1
INSTRUCTIONS: Awarded to any member of the Armed Forces of the State of Connecticut who has completed ten (10)
cumulative years of state or federal military service, and for each additional five (5) years of state or federal military
service. The personnel section will complete the application form and verify the state military service. State military
service includes:
Service in the Connecticut National Guard
Service in the Connecticut State Guard
Service in the Governor’s Guards
Service on the Governor’s Military Staff
Service in any of the branches of the United States Armed Forces
The Commander of the unit will sign the document, certifying that the individual is eligible for the award.
The unit will forward the following:
Connecticut Military Department
Military Administrative Officer
360 Broad Street Room #113
Hartford, Connecticut, 06105-3706
(860) 493-2721 (fax)
Page 1 of 2
CTMD Form 6-2
(New 8/2010)
CONNECTICUT MILITARY DEPARTMENT
LONG SERVICE MEDAL APPLICATION
APPLICANT INFORMATION
Last Name
First Name
Middle Initial
Home Address
City
State
Zip Code
Unit
Rank
Social Security Number
MILITARY SERVICE
Component
Start Date
End Date
RECOMMENDED AWARD:
Previous Award & Permanent Order #
10 year
25 year
40 year
15 year
30 year
20 year
35 year
APPROVALS
I certify that this individual is eligible for this award in accordance with CGS 27-71 and CTNG Regulation 672-1
Preparer:
Date
Signature
Commander:
Date
Signature
TO BE COMPLETED BY CONNECTICUT MILITARY DEPARTMENT
Approved
Date Eligible
Permanent Order #
Disapproved
Reason for Disapproval
Military Administrative Officer
Date
Signature
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