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Illinois Joining Forces Veteran & Family Resource Partner Database
Thank you for completing this resource survey. Please provide as much information about your organization as possible.
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Organization Name *
Organization Street Address *
Organization City *
Organization State *
Organization Zip *
Organization Website *
Organization General Email *
Main Phone Number *
Main Fax Number *
Hours of Operation *
Point of Contact First Name *
Point of Contact Last Name *
Title *
Point of Contact Email *
Point of Contact Phone Number *
Please indicate if your organization provides assistance in one or more of the following categories. *
Required
Does your organization provide any of the following specialized medical services? *
Required
Does your organization provide any of the following integrated/complementary & alternative therapies? *
Required
What military status do you serve? *
Required
What service eras are eligible for your program? *
Required
What military discharge status do you serve? (Check all that apply) *
Required
Does your organization have a hotline? *
Required
Is combat service required to be eligible for your program? *
Does your organization provide veteran peer-to-peer support? *
Required
Does your organization require a DD-214? *
What is your limit for emergency financial assistance? (N/A if it does not apply) *
What is your average turnaround to provide emergency financial assistance? (N/A if it does not apply) *
Is disability a requirement to be part of this program? *
Do clients have to reside in a certain geographic area or county to be eligible for this program? (If yes, please list.) *
Are additional family or household members eligible for this program? *
Do you participate in an IJF Veteran Support Community or other local collaborative? (If yes, please list name and location.) *
I would like to receive more information on partnering with Illinois Joining Forces. *
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