Veteran Application
Please fill out the information below and we will be in contact with you soon. In order to qualify, you must have a documented, service connected injury.
My injury is service connected and I am able to provide official documentation.
Date of Application
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Date of Birth
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Height
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Weight
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First Name
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Last Name
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Address 1
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Address 2
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City
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State
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Zip Code
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Email
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Phone
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Service Requested
note: mobility devices require a DoD or VA rating of a minimum of a 50% rating for mobility related issues and an Honorable Discharge or proof of active duty status. All other requests require a minimum 30% rating
Need
Military Status
Branch of Service
Date of Discharge
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How were you referred to the Independence Corps - Spartan Alliance
Summary of Injury
Injury does not have to be combat related but must have occurred during active service and been documented as a Line of Duty injury.
I was injured........
Your answer
Family Status
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Any Final questions or comments that you wish to add:
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Conclusion
Thank you for taking the time to fill out the Veteran Application. If you have not heard from someone in ten days, please contact Luker@spartanweekend.org of call me at 202-751-0144. After completing a brief phone interview you will be required to provide some requested documentation (e.g. DD214 and breakdown of disability rating). By completing this application you acknowledge that the SAVE Alliance has the right to share your information with our partner organizations within the Spartan Alliance. Our services are provided as funding allows and on a case by case basis.
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