Reboot Workshop Application

| Resume a previously saved form
Resume Later

In order to be able to resume this form later, please enter your email and choose a password.

Page 1 - Military Information


Military Service












Command Information





War Served






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



Page 2 - Personal Information

Personal Information















Current Address (If Different from Permanent Address)




Referral Information





Page 3 - Workshop Pre-Survey

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




Page 4 - 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. 


Need assistance with this form?