EmailMe Form - VETERANS MINISTRY INTEREST FORM

ABOUT THE MINISTRY

The Veterans Ministry will engage, educate and inform our Veterans Community regarding resources, events, benefits and any VA programs that are available.

1. Name *

First Last

2. Phone *

### - ### - ####

3. Email *

4. BRANCH OF SERVICE *

5. YEARS OF SERVICE *

6. MILITARY RANK (Check all that apply) *

7. What services or programs are you interested in? (Check all that apply) *

Career counseling

Financial/Housing assistance

Social events/networking

VA benefits guidance: Assigned primary medical & dental care

VA benefits guidance: 24-Hour suicide prevention support

VA benefits guidance: Physical rehabilitation outlets

VA benefits guidance: On-call counseling

VA benefits guidance: Education & training opportunities

8. Are you currently employed? *

Yes

No

9. Are you interested in volunteering or mentoring other veterans? *

Yes

No

10. Do you have any specific challenges you're facing as a veteran?
If yes, please briefly describe in the box below. *

Yes

No

11. Would you like to be contacted about upcoming events or opportunities? *

Yes

No