Veteran's Registration for Stand Down
This is the Pre-Registration Form. Please fill in as much of the following information as possible and then click the 'Submit' button at the bottom.
Last Name First Name Middle Name
Social Security # Branch of Service Select All Army Navy Marines Air Force Coast Guard National Guard Dates of Service
Did you serve in a war zone? Yes or No Yes No Where?
Birthdate Birthplace
Message Address City State Zip
Message Phone Email Address
Have you ever attended Stand Down Before? Yes or No No Yes Where? When? ?
Height Weight Hair Color Eye Color Gender Choose One Male Female Ethnicity Choose One White Black Asian Hispanic Native American Other
Highest Grade Completed Usual Occupation Last Wage Date Last Employed? How Long Have You Been Homeless?
Current Medical Problems (check all that apply): Dental Hearing Vision Feet Skin Internal Drug Alcohol PTSD Emotional Other
Do You Need Help With Outstanding Warrants? Yes or No Yes No Other Legal problems? (describe)
Will any dependent family member(s) be attending with you? Yes or No Yes No # of adults # of children
If you have any comments, special circumstances, or other issues that can help us accommodate your attendence, please list them here:
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