District 11A Veterans Treatment Court Eligibility Questionnaire
NOTE: The information you provide is anonymous. The stats gathered are used to determine the need for Veterans assistance in Harnett County. Your participation is crucial and greatly appreciated.

Please contact the Veterans Treatment Court Coordinator, LTC (R) Mark Teachey (910)814-4515, if you would like to receive more information about the Veteran's Treatment Court. You can also visit the program office on the 1st Floor of the Harnett County Courthouse.

Name *
Your answer
Telephone # *
Your answer
Age *
Your answer
Race *
Your answer
What have you been charged with? *
Your answer
What county do you live in? *
Your answer
Have you ever served in the Military? *
Military Rank *
(Ex. Sergeant, Specialist, Lance Corporal, etc...)
Your answer
What Branch of the Armed Forces did you serve on Active Duty? *
Have you ever served in any Hostile Combat Operations while on Active Duty? *
What type of Military Discharge did you receive? *
Have you ever been homeless since being discharged from the military? *
Are you affiliated with a VA Medical Center? *
If Yes, please put Disability %
Your answer
Do you have access to your DD214? *
Do you have a Lawyer? *
If Yes, please list their name.
Your answer
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