1 Civic Center Plaza, 2nd Floor
Irvine, CA 92606
* Active duty includes Coast Guard in time of war, and active duty or mobilized reservists.
Date of Birth *
Date of Enlistment
Anticipated Date of Discharge
Please upload a high-resolution official Military photo (300 to 600 dpi) of the Service Member.
The City of Irvine takes your privacy seriously. This form asks you to provide the City with certain personal information. Such information is being requested and will be utilized by the City for the specific and limited purpose of future City correspondence regarding the subject matter of this form. Pursuant to Measure S, an initiative ordinance passed by City voters in 2008, the personal information noted by an asterisk (*) on this form will be kept confidential. Unless you expressly indicate to us otherwise or unless compelled by a court order, it will not be shared with other agencies, business, or individuals.