Transitioning Military & Veteran Workforce Development Intake

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Page 1 - General Information

Personal Information

non-military email address

(to select more that 1 option hold down the control button)
Please Rate your experience of the following on a scale of 1 to 5:

1 - No Knowledge
2 - Beginner
3 - Basic
4 - Intermediate
5 - Advanced
1 2 3 4 5
Living Situation

Family Information

Total household Gross wages and salaries before deductions.
Employment Information
If you are not employed, please answer the following questions:

Emergency Contact Information

Referral Information

Page 2 - Military Information

Military Service

Command Information

War Served

Services Provided

Follow Up Agreement

Newsletter Consent

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.