Reboot Workshop Application

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Personal Information

Current Address (If Different from Permanent Address)

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Military Service

Command Information

War Served

Employment Information

If you are not employed, please answer the following questions:

Referral Information

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The following questions are part of a pre-REBOOT workshop survey.  Your responses will have no bearing on your application to attend a workshop.  We collect this information to evaluate the REBOOT workshop and the data can help us obtain more funding so that additional veterans can attend.  Please answer all questions.                       


For each statement below, please read carefully and indicate how much confidence you have that you could accomplish each of these tasks or beliefs by marking your answer according to the following 5-point scale.

1 = No Confidence

2 = Very Little Confidence

3 = Moderate Confidence

4 = Confidence

5 = Complete Confidence

Additional Questions

Photograph and Video Consent to Release

I hereby grant the National Veterans Transition Services, Inc. (NVTSI) permission to use my 

likeness in a photograph or video in any and all of its publications, including web site entries, 

without payment or consideration.

I understand and agree that these materials will become the property of the National Veterans 

Transition Services, Inc. and will not be returned.

I hereby irrevocably authorize the National Veterans Transition Services, Inc. to edit, alter, 

exhibit, publish or distribute this photo for the purposes of publicizing the National Veterans 

Transition Services, Inc.’s programs or for any other lawful purpose. In addition, I waive the 

right to inspect or approve the finished product, including written or electronic copy, wherein my 

likeness appears. Additionally, I waive my right to royalties or any other compensation arising 

or related to the use of the photograph.

I hereby hold harmless and release and forever discharge the National Veterans Transition 

Services, Inc. from all claims, demands, and causes of action which I, my heirs, representatives, 

executors, administrators, or any other persons acting on my behalf or on behalf of my estate 

have or may have by reason of this authorization.

I am 21 years of age and am competent to contract in my own name. I have read this release 

and I fully understand the contents, meaning, and impact of this release. 

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