Wis. Stats. Chapter 45	2135 Rimrock Road, P.O. Box 7843, Madison, WI 53707-7843 (608) 266-1311 | 1-800-WIS-VETS (947-8387) | WisVets.com
ELIGIBILITY APPLICATION For WisDOT VETERAN IDENTIFIER
The provision of your social security number is mandatory under the Wisconsin Statutes. Your social security number will be used to verify your identity. If you do not provide your social security number, processing may be delayed.

Completion of this application will result in the certification of veteran status for inclusion of the VETERAN identifier on your State of Wisconsin driver’s license or identification card, assuming all eligibility criteria are met.
Please include the DD214/DD215, your discharge document, with this completed form.
Veteran’s Name:
First	Middle	Last
Veteran’s Address:
Street	City	State	Zip Code	County
Update my address on file with the above address.
Phone Number:
Phone Number, include area code and extension	Phone Number, include area code and extension
Veteran’s Social Security Number:	(required to verify your identification)
Veteran’s Date of Birth:
How do you want to receive correspondence relating to this eligibility request?
Send to above address
Send to this email address:
(faster response by email)
Under penalties of law, I declare that the above information is true, correct and complete, to the best of my knowledge.
Veteran’s Signature	Date