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Application for Review
Please complete and submit answers to the following. Upon our receipt, your information will be screened and authenticated for further review and additional screening by our team.
Thank you for your service!
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* Required
Email
*
Your email
Veteran First Name
*
Your answer
Veteran Last Name
*
Your answer
Address
*
Your answer
Phone
*
Your answer
Are you married?
*
Yes
No
Other:
Spouse's Full Name
Your answer
Branch of Service
*
Air Force
Army
Marine
Navy
Coast Guard
Years of Service
*
Your answer
Discharge
*
Honorable
Dishonorable
Other than Honorable
Deployments
*
Your answer
Do you have a disability?
*
Yes
No
Prefer not to answer
Service Connected Disabilities & Current Rating (Disclosure of this information is OPTIONAL. If you do not wish to disclose either way, please type "private" in the space below.
*
Your answer
Do you have any children?
*
Yes
No
If yes, please include how many, age(s) and sex.
Your answer
Though this house will be provided mortgage free, there are costs associated with owning a home. Are you able to manage and support owning a house financially?
*
Yes
No
Other:
If you are to be selected for the next step in the screening process, do you certify that you will provide us with any documents needed such as DD-214, credit report and any other information upon request?
*
Yes
No
Please write below a little about you and your family and what it would mean to be given this house.
*
Your answer
Please check below if you are completing this on behalf of the veteran and understand that we will be contacting the veteran with the information you provided above. Include your name and phone number in the "Other" section below.
This form was completed on behalf of the veteran.
Other:
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