Intake Assessment Step 1

Enrollment Form

If you are interested in resources in the areas of employment, education, housing and health care; you've come to the right place!

You will NOT be able to save your registration information and come back to it at a later time, so please have the following items ready to attach before you start:

An updated resume, preferably in Word document format
DD214 form (Black out your social security number)
- A good site for DD-214 reference, describing the various alternatives to access your DD-214 is http://dd214.us/methods.html
A valid picture ID, preferably your VA ID card

Please contact us at 214-438-6358 if you have any questions before starting the enrollment process.

Personal Information

First

Last

Gender

Date of Birth

LinkedIn Url

Street Address

Zip Code

City

State

Phone

Service Information

Note: If you are a military spouse, please provide the veteran/service member’s information.

Source of Referral

Current Status

Branch of Service

Dates Served From

Dates Served To

Era

Military Specialty (Military Specialty Title & MOS, Rate, AFSC, etc.)

Last Rank Held

Discharge Type

Disabled

Yes

Service Connected

Yes

Rating