Student Veterans Retreat Application Form

First Name: *

Last Name: *

Date of Birth: *

mm/dd/yyyy

Primary Phone: *

123-456-7890

Cell Phone: *

123-456-7890; May be the same as primary phone.

Email Address: *

Personal email is preferred.

Street Address: *

City: *

State: *

Zip Code: *

Are you a veteran or service member who has served since September 11, 2001?: *

Locations(s) and dates of deployments: *

(mm/yyyy)

Evidence of Military Service: *

Please upload a scanned copy of your DD214
OR
Email your DD214 to contact@cominghomeproject.net
OR
Fax your DD214 to 415-386-8721 (include your name and contact number somewhere on the document)

Applications will not be considered complete until this documentation is submitted.

Evidence of Enrollment: *

Please upload and submit a copy of your current student ID.
OR
Email it to contact@cominghomeproject.net
OR
Fax it to 415-386-8721

Applications will not be considered complete until this documentation is submitted.

Where do you attend school?: *

What do you study?: *

Status of enrollment: *

Full-time

Part-time

Transportation:

I want to help coordinate a carpool

I want to drive a carpool

I need transportation

Why would you like to attend the retreat?: *

What would you like to get from this retreat?: *

Medical Form

Medical Form: *

Please upload your completed medical form here. If you have any problems uploading the document, please email contact@cominghomeproject.net, or call 415-353-5363.

Have you attended other CHP events?: *

If so, which events?:

If "Other", please explain:

Any additional information you would like us to know about you?:

The Coming Home Project

Student Veterans Retreat Application Form