Upstate Stand Down Veteran Registration
Event Timing: October 1st, 2021
Event Address: 385 N Church St, Spartanburg, SC 29303
Full Name *
Phone Number *
Email *
County *
Veteran Status *
Gender
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Street Address
City
State
Race/Ethnicity
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Service From Date
MM
/
DD
/
YYYY
Service To Date
MM
/
DD
/
YYYY
Experienced Traumatic Brain Injury?
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In Combat?
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Other Combat
Are you currently homeless?
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How long?
In the last 3 years were you...
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Do you consider yourself to be at risk of being homeless within the next...
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If you are not currently homeless, or at risk of becoming homeless, but are a veteran in need of services please describe your need(s)
Attended a Stand Down before?
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When/Where?
Applied for VA medical benefits?
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Applied for other VA benefits?
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Receiving VA healthcare?
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Receiving VA monetary benefits?
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Current Medical Needs
Problems with...
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If "other", please describe
Mental Health Needs
Will you utilize any of the services below?
Will a Spouse/Companion attend Stand Down with you?
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Will a dependent child 18 or younger attend?
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List gender and age of all children who will attend
I do hereby hold harmless and release from responsibility Operation Restoration / Upstate Stand Down, Restoration Church Expo Center, the VA, the county of Spartanburg and any and all support and service providers for any and all injury to myself or any members of my family, be it self-inflicted or as a result of others while a participant of the Upstate Stand Down. I acknowledge that all information collected on this form is confidential and will only be used for the purpose of the Upstate Stand Down. *
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Do you want to receive our newsletter and occasional announcements?
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Are you submitting this form on behalf of the veteran?
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Submitted by name
Submitted by Phone
Submitted by email
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