Veteran Information

First & Last Name

Service branch & dates of service

How (the Veteran) would like to be addresses? (Title/Pronoun/Nickname/etc...)

Where are they located (City & County)

Reason for the request (Tell the story)

What specificaly they are requesting assistance with and when do they need it by?

Best way to communicate directly with the Veteran if contact is to be made with the Veteran (Cell/Text/Email and contact info)

Person making the request (if not the Veteran)

Name, organization and contact information

Do you have proof/verification of service available?

(Department of Defense Form 214 (discharge documentation), Current service records, VA ID card, Vendor Inquiry System, Hospital Inquiry Information, Other verification of service accepted on a case-by-case basis.)

Any Other Information?

Any specific information such as Veteran service organization memberships or clubs, combat service, or service connected information please add it to the request.

**Disclosure:** Please be aware that the information you are about to submit will be reviewed and shared with our coalition resources. Do not submit any personal information that the veteran or family member does not wish to have made public. Some requests may be forwarded to state and national resources for additional assistance. If you or the requester do not receive a response from one of our resources within three days, please send us an email so that we can follow up. Thank you for trusting our coalition with your request.

The Capital Region Veterans Coalition