{"id":5757,"date":"2025-06-05T13:43:24","date_gmt":"2025-06-05T18:43:24","guid":{"rendered":"https:\/\/vetaffairs.la.gov\/?page_id=5757"},"modified":"2025-06-30T16:47:34","modified_gmt":"2025-06-30T21:47:34","slug":"huy-chuong-vinh-danh-cuu-chien-binh-louisiana","status":"publish","type":"page","link":"https:\/\/vetaffairs.la.gov\/vi\/louisiana-veterans-honor-medal","title":{"rendered":"Huy ch\u01b0\u01a1ng danh d\u1ef1 c\u1ef1u chi\u1ebfn binh Louisiana"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"5757\" class=\"elementor elementor-5757\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-8e20d7d e-flex e-con-boxed e-con e-parent\" data-id=\"8e20d7d\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ffe0a9c elementor-hidden-desktop elementor-hidden-tablet elementor-hidden-mobile elementor-widget elementor-widget-text-editor\" data-id=\"ffe0a9c\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>The Louisiana Veterans Honor Medal was created to honor, recognize and thank Louisiana Veterans for their honorable military service. Medals are available to all honorably discharged Louisiana Veterans and to the family of those killed in action.<\/p><p>The Louisiana Veterans Honor Medal is available with a blue ribbon for honorable discharge, a purple ribbon for Purple Heart recipients, a black ribbon for Prisoners of War, and a yellow ribbon for killed in action.<\/p><p>For more information, call toll free at <a href=\"tel:18774328982\">1-877-432-8982<\/a>.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ea039d7 elementor-widget elementor-widget-text-editor\" data-id=\"ea039d7\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>The Louisiana Veterans Honor Medal was created to recognize and thank Louisiana veterans for their honorable military service. Medals are available to all honorably discharged Louisiana veterans, and to the families of those Killed in Action.<\/p>\n<p>The Louisiana Veterans Honor Medal is available with a blue ribbon for honorable discharge; a purple ribbon for Purple Heart recipients; a black ribbon for Prisoners of War\/Missing in Action; and a yellow ribbon for those Killed in Action.<\/p>\n<p>Louisiana veterans, or families of those Killed in Action, can submit an online application or&nbsp;<a href=\"\/wp-content\/uploads\/2025\/06\/Honor-Medal-Application.pdf\" target=\"_blank\" rel=\"noopener\">complete a fillable PDF application<\/a>&nbsp;and submit via email to <a href=\"mailto:holly.talley@la.gov\">holly.talley@la.gov<\/a>, fax to (225) 219-5590, or mail to Louisiana Department of Veterans Affairs, ATTN: Honor Medal, PO Box 94095, Baton Rouge, LA 70804-9095. Applicants may also request an application be sent to them by emailing the address listed above or by calling <a href=\"tel:2252193700\">(225) 219-3700<\/a>.<\/p>\n<p>For more information about the Louisiana Veterans Honor Medal, or help with an application, call (<a href=\"tel:2252193700\">225) 219-3700<\/a> or email <a href=\"mailto:holly.talley@la.gov\">holly.talley@la.gov<\/a>.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-19ad517 elementor-widget elementor-widget-heading\" data-id=\"19ad517\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Apply for the Louisiana Veterans Honor Medal:<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a78b093 elementor-widget elementor-widget-text-editor\" data-id=\"a78b093\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>*Note: If you would rather not apply online, please <a href=\"\/wp-content\/uploads\/2025\/06\/Honor-Medal-Application.pdf\" target=\"_blank\" rel=\"noopener\">download a fillable PDF application<\/a>.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-428801d elementor-widget elementor-widget-shortcode\" data-id=\"428801d\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-shortcode\"><script>\nvar 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   <p class='gform_description'><div class=\"gf-logic-announcer sr-only\" aria-live=\"polite\">placeholder<\/div><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_6' id='gform_6' class='honor-medals-form' action='\/vi\/wp-json\/wp\/v2\/pages\/5757#gf_6' data-formid='6' novalidate>\t\t\t\t\t<div style=\"display: none !important;\" class=\"akismet-fields-container gf_invisible\" data-prefix=\"ak_\">\n\t\t\t\t\t\t<label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label>\n\t\t\t\t\t\t<input type=\"hidden\" id=\"ak_js_1\" name=\"ak_js\" value=\"148\" \/>\n\t\t\t\t\t\t<script>\ndocument.getElementById( \"ak_js_1\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n\n\t\t\t\t\t<\/div><div class='gf_invisible ginput_recaptchav3'  data-tabindex='0'><input id=\"input_4a79835752d484794e1f1310d08e6042\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_4a79835752d484794e1f1310d08e6042\" value=\"\"\/><\/div>\n        <div id='gf_progressbar_wrapper_6' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">Step <span class='gf_step_current_page'>1<\/span> of <span class='gf_step_page_count'>2<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_50' style='width:50%;'><span>50%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_6_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_6' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_6_1\" class=\"gfield gfield--type-html gfield--input-type-html section-title gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2>Veteran\u2019s Information<\/h2><\/div><fieldset id=\"field_6_3\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_6_3'>\n                            \n                            <span id='input_6_3_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.3' id='input_6_3_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                    <label for='input_6_3_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_6_3_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_3.6' id='input_6_3_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                    <label for='input_6_3_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_6_4\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gender-field gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_6_4'>\n\t\t\t<div class='gchoice gchoice_6_4_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Male'  id='choice_6_4_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_4_0' id='label_6_4_0' class='gform-field-label gform-field-label--type-inline'>Male<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_4_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Female'  id='choice_6_4_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_4_1' id='label_6_4_1' class='gform-field-label gform-field-label--type-inline'>Female<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_7\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Check all the apply<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_6_7'><div class='gchoice gchoice_6_7_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.1' type='checkbox'  value='Living'  id='choice_6_7_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_7_1' id='label_6_7_1' class='gform-field-label gform-field-label--type-inline'>Living<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_7_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.2' type='checkbox'  value='Deceased'  id='choice_6_7_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_7_2' id='label_6_7_2' class='gform-field-label gform-field-label--type-inline'>Deceased<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_7_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.3' type='checkbox'  value='Killed in action'  id='choice_6_7_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_7_3' id='label_6_7_3' class='gform-field-label gform-field-label--type-inline'>Killed in action<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_7_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.4' type='checkbox'  value='Purple Heart'  id='choice_6_7_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_7_4' id='label_6_7_4' class='gform-field-label gform-field-label--type-inline'>Purple Heart<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_6_7_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_7.5' type='checkbox'  value='POW\/MIA'  id='choice_6_7_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_6_7_5' id='label_6_7_5' class='gform-field-label gform-field-label--type-inline'>POW\/MIA<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_6_8\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_6_8' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_6_8_1_container' >\n                                        <input type='text' name='input_8.1' id='input_6_8_1' value=''    aria-required='true'   autocomplete=\"address-line1\" \/>\n                                        <label for='input_6_8_1' id='input_6_8_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_6_8_3_container' >\n                                    <input type='text' name='input_8.3' id='input_6_8_3' value=''    aria-required='true'   autocomplete=\"address-level2\" \/>\n                                    <label for='input_6_8_3' id='input_6_8_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_6_8_4_container' >\n                                        <select name='input_8.4' id='input_6_8_4'     aria-required='true'   autocomplete=\"address-level1\" ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' selected='selected'>Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_6_8_4' id='input_6_8_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_6_8_5_container' >\n                                    <input type='text' name='input_8.5' id='input_6_8_5' value=''    aria-required='true'   autocomplete=\"postal-code\" \/>\n                                    <label for='input_6_8_5' id='input_6_8_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_8.6' id='input_6_8_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_6_9\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_9'>Parish\/County<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_9' id='input_6_9' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select Parish\/County' >Select Parish\/County<\/option><option value='Other - outside of Louisiana' >Other - outside of Louisiana<\/option><option value='Acadia' >Acadia<\/option><option value='Allen' >Allen<\/option><option value='Ascension' >Ascension<\/option><option value='Assumption' >Assumption<\/option><option value='Avoyelles' >Avoyelles<\/option><option value='Beauregard' >Beauregard<\/option><option value='Bienville' >Bienville<\/option><option value='Bossier' >Bossier<\/option><option value='Caddo' >Caddo<\/option><option value='Calcasieu' >Calcasieu<\/option><option value='Caldwell' >Caldwell<\/option><option value='Cameron' >Cameron<\/option><option value='Catahoula' >Catahoula<\/option><option value='Claiborne' >Claiborne<\/option><option value='Concordia' >Concordia<\/option><option value='De Soto' >De Soto<\/option><option value='East Baton Rouge' >East Baton Rouge<\/option><option value='East Carroll' >East Carroll<\/option><option value='East Feliciana' >East Feliciana<\/option><option value='Evangeline' >Evangeline<\/option><option value='Franklin' >Franklin<\/option><option value='Grant' >Grant<\/option><option value='Iberia' >Iberia<\/option><option value='Iberville' >Iberville<\/option><option value='Jackson' >Jackson<\/option><option value='Jefferson' >Jefferson<\/option><option value='Jefferson Davis' >Jefferson Davis<\/option><option value='La Salle' >La Salle<\/option><option value='Lafayette' >Lafayette<\/option><option value='Lafourche' >Lafourche<\/option><option value='Lincoln' >Lincoln<\/option><option value='Livingston' >Livingston<\/option><option value='Madison' >Madison<\/option><option value='Morehouse' >Morehouse<\/option><option value='Natchitoches' >Natchitoches<\/option><option value='Orleans' >Orleans<\/option><option value='Ouachita' >Ouachita<\/option><option value='Plaquemines' >Plaquemines<\/option><option value='Pointe Coupee' >Pointe Coupee<\/option><option value='Rapides' >Rapides<\/option><option value='Red River' >Red River<\/option><option value='Richland' >Richland<\/option><option value='Sabine' >Sabine<\/option><option value='St. Bernard' >St. Bernard<\/option><option value='St. Charles' >St. Charles<\/option><option value='St. Helena' >St. Helena<\/option><option value='St. James' >St. James<\/option><option value='St. John The Baptist' >St. John The Baptist<\/option><option value='St. Landry' >St. Landry<\/option><option value='St. Martin' >St. Martin<\/option><option value='St. Mary' >St. Mary<\/option><option value='St. Tammany' >St. Tammany<\/option><option value='Tangipahoa' >Tangipahoa<\/option><option value='Tensas' >Tensas<\/option><option value='Terrebonne' >Terrebonne<\/option><option value='Union' >Union<\/option><option value='Vermilion' >Vermilion<\/option><option value='Vernon' >Vernon<\/option><option value='Washington' >Washington<\/option><option value='Webster' >Webster<\/option><option value='West Baton Rouge' >West Baton Rouge<\/option><option value='West Carroll' >West Carroll<\/option><option value='West Feliciana' >West Feliciana<\/option><option value='Winn' >Winn<\/option><\/select><\/div><\/div><div id=\"field_6_10\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_10'>Branch of Service<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_6_10' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_11\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_11'>Rank Held Upon Discharge<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_6_11' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_6_12\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_12'>Entered Active Duty<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_12' id='input_6_12' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_6_12_date_format gfield_description_6_12\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_6_12_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_6_12' class='gform_hidden' value='https:\/\/vetaffairs.la.gov\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_6_12'>Format: mm\/dd\/yyyy<\/div><\/div><div id=\"field_6_13\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_13'>Exited Active Duty<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_13' id='input_6_13' type='text' value='' class='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_6_13_date_format gfield_description_6_13\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_6_13_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_6_13' class='gform_hidden' value='https:\/\/vetaffairs.la.gov\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_6_13'>Format: mm\/dd\/yyyy<\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_6_14' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Next'  \/> <button type='button'  id='gform_save_6_2_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  ><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> SAVE AND CONTINUE LATER<\/button>\n                    <\/div>\n                <\/div>\n                <div id='gform_page_6_2' class='gform_page' data-js='page-field-id-14' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_6_2' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_6_15\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full section-title gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2>Applicant Information<\/h2><\/div><div id=\"field_6_16\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full section-subtitle gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><p>(For those applying on behalf of a veteran; One medal per veteran.):<\/p><\/div><fieldset id=\"field_6_17\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Name<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_6_17'>\n                            \n                            <span id='input_6_17_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_17.3' id='input_6_17_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_6_17_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_6_17_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_17.6' id='input_6_17_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_6_17_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_6_20\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_20'>Relationship to Veteran<\/label><div class='ginput_container ginput_container_select'><select name='input_20' id='input_6_20' class='large gfield_select'     aria-invalid=\"false\" ><option value='Select relationship' >Select relationship<\/option><option value='Veteran' >Veteran<\/option><option value='Spouse' >Spouse<\/option><option value='Child' >Child<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_6_21\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_21'>Other<\/label><div class='ginput_container ginput_container_text'><input name='input_21' id='input_6_21' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_6_19\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Address<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_6_19' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_6_19_1_container' >\n                                        <input type='text' name='input_19.1' id='input_6_19_1' value=''    aria-required='false'    \/>\n                                        <label for='input_6_19_1' id='input_6_19_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_6_19_3_container' >\n                                    <input type='text' name='input_19.3' id='input_6_19_3' value=''    aria-required='false'    \/>\n                                    <label for='input_6_19_3' id='input_6_19_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_6_19_4_container' >\n                                        <select name='input_19.4' id='input_6_19_4'     aria-required='false'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='American Samoa' >American Samoa<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Guam' >Guam<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' >Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' selected='selected'>Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='U.S. Virgin Islands' >U.S. Virgin Islands<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_6_19_4' id='input_6_19_4_label' class='gform-field-label gform-field-label--type-sub '>State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_6_19_5_container' >\n                                    <input type='text' name='input_19.5' id='input_6_19_5' value=''    aria-required='false'    \/>\n                                    <label for='input_6_19_5' id='input_6_19_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_19.6' id='input_6_19_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_6_25\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_25'>Parish\/County<\/label><div class='ginput_container ginput_container_select'><select name='input_25' id='input_6_25' class='large gfield_select'     aria-invalid=\"false\" ><option value='Select Parish\/County' >Select Parish\/County<\/option><option value='Other - outside of Louisiana' >Other - outside of Louisiana<\/option><option value='Acadia' >Acadia<\/option><option value='Allen' >Allen<\/option><option value='Ascension' >Ascension<\/option><option value='Assumption' >Assumption<\/option><option value='Avoyelles' >Avoyelles<\/option><option value='Beauregard' >Beauregard<\/option><option value='Bienville' >Bienville<\/option><option value='Bossier' >Bossier<\/option><option value='Caddo' >Caddo<\/option><option value='Calcasieu' >Calcasieu<\/option><option value='Caldwell' >Caldwell<\/option><option value='Cameron' >Cameron<\/option><option value='Catahoula' >Catahoula<\/option><option value='Claiborne' >Claiborne<\/option><option value='Concordia' >Concordia<\/option><option value='De Soto' >De Soto<\/option><option value='East Baton Rouge' >East Baton Rouge<\/option><option value='East Carroll' >East Carroll<\/option><option value='East Feliciana' >East Feliciana<\/option><option value='Evangeline' >Evangeline<\/option><option value='Franklin' >Franklin<\/option><option value='Grant' >Grant<\/option><option value='Iberia' >Iberia<\/option><option value='Iberville' >Iberville<\/option><option value='Jackson' >Jackson<\/option><option value='Jefferson' >Jefferson<\/option><option value='Jefferson Davis' >Jefferson Davis<\/option><option value='La Salle' >La Salle<\/option><option value='Lafayette' >Lafayette<\/option><option value='Lafourche' >Lafourche<\/option><option value='Lincoln' >Lincoln<\/option><option value='Livingston' >Livingston<\/option><option value='Madison' >Madison<\/option><option value='Morehouse' >Morehouse<\/option><option value='Natchitoches' >Natchitoches<\/option><option value='Orleans' >Orleans<\/option><option value='Ouachita' >Ouachita<\/option><option value='Plaquemines' >Plaquemines<\/option><option value='Pointe Coupee' >Pointe Coupee<\/option><option value='Rapides' >Rapides<\/option><option value='Red River' >Red River<\/option><option value='Richland' >Richland<\/option><option value='Sabine' >Sabine<\/option><option value='St. Bernard' >St. Bernard<\/option><option value='St. Charles' >St. Charles<\/option><option value='St. Helena' >St. Helena<\/option><option value='St. James' >St. James<\/option><option value='St. John The Baptist' >St. John The Baptist<\/option><option value='St. Landry' >St. Landry<\/option><option value='St. Martin' >St. Martin<\/option><option value='St. Mary' >St. Mary<\/option><option value='St. Tammany' >St. Tammany<\/option><option value='Tangipahoa' >Tangipahoa<\/option><option value='Tensas' >Tensas<\/option><option value='Terrebonne' >Terrebonne<\/option><option value='Union' >Union<\/option><option value='Vermilion' >Vermilion<\/option><option value='Vernon' >Vernon<\/option><option value='Washington' >Washington<\/option><option value='Webster' >Webster<\/option><option value='West Baton Rouge' >West Baton Rouge<\/option><option value='West Carroll' >West Carroll<\/option><option value='West Feliciana' >West Feliciana<\/option><option value='Winn' >Winn<\/option><\/select><\/div><\/div><div id=\"field_6_22\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_22'>Email Address<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_22' id='input_6_22' type='email' value='' class='large'     aria-invalid=\"false\" aria-describedby=\"gfield_description_6_22\" \/>\n                        <\/div><div class='gfield_description' id='gfield_description_6_22'>Format: sample@domain.com<\/div><\/div><div id=\"field_6_23\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--width-half field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_23'>Phone Number<\/label><div class='ginput_container ginput_container_phone'><input name='input_23' id='input_6_23' type='tel' value='' class='large'    aria-invalid=\"false\" aria-describedby=\"gfield_description_6_23\"  \/><\/div><div class='gfield_description' id='gfield_description_6_23'>Format: (123) 456-7890<\/div><\/div><div id=\"field_6_26\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full section-title gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2>Preferences<\/h2><\/div><fieldset id=\"field_6_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full preferences-choices field_sublabel_below gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Untitled<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_6_27'>\n\t\t\t<div class='gchoice gchoice_6_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='I would like to have my Medal awarded to me at a Veterans Honor Medal Ceremony'  id='choice_6_27_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_27_0' id='label_6_27_0' class='gform-field-label gform-field-label--type-inline'>I would like to have my Medal awarded to me at a Veterans Honor Medal Ceremony<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='I would like to have my Medal mailed to me at the above listed address'  id='choice_6_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_27_1' id='label_6_27_1' class='gform-field-label gform-field-label--type-inline'>I would like to have my Medal mailed to me at the above listed address<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_6_27_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='I would like to receive my Medal at my local LDVA Parish Service Office'  id='choice_6_27_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_6_27_2' id='label_6_27_2' class='gform-field-label gform-field-label--type-inline'>I would like to receive my Medal at my local LDVA Parish Service Office<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_6_28\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_6_28'>Upload DD214 here.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='134217728' \/><input name='input_28' id='input_6_28' type='file' class='large' aria-describedby=\"gfield_upload_rules_6_28\" onchange='javascript:gformValidateFileSize( this, 134217728 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_6_28'>Max. file size: 128 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_6_28'><\/div> <\/div><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><input type='submit' id='gform_previous_button_6' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Previous'  \/> <input type='submit' id='gform_submit_button_6' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Submit'  \/> <button type='button'  id='gform_save_6_footer_link' onclick='gform.submission.handleButtonClick(this);' data-submission-type='save-continue' class='gform_save_link gform-theme-button gform-theme-button--secondary button'  ><svg aria-hidden=\"true\" focusable=\"false\" width=\"16\" height=\"16\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path fill-rule=\"evenodd\" clip-rule=\"evenodd\" d=\"M0 8a4 4 0 004 4h3v3a1 1 0 102 0v-3h3a4 4 0 100-8 4 4 0 10-8 0 4 4 0 00-4 4zm9 4H7V7.414L5.707 8.707a1 1 0 01-1.414-1.414l3-3a1 1 0 011.414 0l3 3a1 1 0 01-1.414 1.414L9 7.414V12z\" fill=\"#6B7280\"\/><\/svg> SAVE AND CONTINUE LATER<\/button><input type='hidden' name='gform_ajax' value='form_id=6&amp;title=&amp;description=1&amp;tabindex=0&amp;theme=orbital&amp;styles=[]&amp;hash=66f5e2ba81162256ce5f0cb4d6d60fe7' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_6' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_6' id='gform_theme_6' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_6' id='gform_style_settings_6' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_6' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='6' \/>\n            <input type='hidden' class='gform_hidden' name='gform_save' id='gform_save_6' value='' \/>\n                             <input type='hidden' class='gform_hidden' name='gform_resume_token' id='gform_resume_token_6' value='' \/>\n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='USD' value='eUnrilj90LvuDsdZ3jD4gR0kRYCinz7n12\/Mdy2COQVj39Z8CnUp6HJ1QzoEyKEyaaaaDqRmFr5jpy55h70DKOOICJtDR5vxXIos6DMltPSIzSI=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input 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