Portland Metro Veterans Employment Services: Application for Services
Welcome to Easterseals Oregon Homeless Veteran Reintegration Program (HVRP).

*All responses will be provided to Veteran upon submission.
Email address *
First Name: *
Your answer
Last Name: *
Your answer
Phone Number: *
Your answer
Address: *
Your answer
Street Address:
Your answer
City: *
Your answer
State: *
Your answer
Postal/Zip Code: *
Your answer
Current County of Residence: *
Emergency Contact: *
Your answer
Characterization of Discharge: *
Have you served at least one day of Active Duty other than Basic Training? *
Are you Chronically homeless? A chronically homeless individual is defined to mean a homeless individual who has met the definition of homelessness continuously for at least 12 months, or on at least four separate occasions in the last 3 years, where the combined occasions total a length of time of at least 12 months. *
Please describe your living situation (Homeless, Renting, Staying w/ Friends, etc.): *
Your answer
Are you currently looking for work? *
Ethnicity *
Branch of Military Service *
What are your current employment needs? *
How did you hear about HVRP? *
A copy of your responses will be emailed to the address you provided.
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