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Are you (or your spouse) separating/have you separated from active duty military service in southern California (San Diego, Riverside, Imperial or Orange counties)?
Please select...
Yes
No
From what location/installation are you separating/did you separate from active duty service?
Where do you plan to reside after separation?
Please select...
Southern California (SD, Orange, Riverside, Imperial, San Bernadino Counties)
I am not sure
Other
Other: Plan to reside
First Name:
Last Name:
Email address (please do not use your military email)
(non-military Email)
Phone number:
Current Address: Street
Please do not use a PO Box or APO/FLO
City
State
Zip
Identified gender?
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Male
Female
Non-binary
Other
Prefer not to state
Ethnicity
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American Indian or Alaska Native
Asian
Black or African American
Middle Eastern
Native Hawaiian or Other Pacific Islander
Hispanic or Latino/a
White
Two or More
Prefer not to disclose
Where did you hear about zero8hundred?
Please select...
TAPS Anchors
TAPS Bowling Alley
TAPS Coronado
TAPS Point Loma
Miramar TRS
Camp Pendelton TRS
MCRD TRS
Coast Guard TAPS
Military Family Collaborative Spouse Class
STARS Class
Command
Bavaria ENPP
Camp Lejeune ENPP
Camp Pendleton ENPP
Charleston ENPP
Cherry Point ENPP
Fort Benning ENPP
Fort Drum ENPP
Fort Eustis ENPP
Fort Shafter ENPP
Fort Sill ENPP
Kadena ENPP
Langley ENPP
Little Creek ENPP
Miramar ENPP
Norfolk ENPP
Okinawa ENPP
Schofield Barracks ENPP
Pearl Harbor-Hickam ENPP
Travis ENPP
Yokosuka ENPP
Spouse
Friend
Social Media (please specify)
Base Advertising (please specify)
Website
Other (please specify)
Social Media, Base Advertising or Other: please specify
Please choose the role that best describes you.
Please select...
Active Duty
Veteran
Reservist
National Guard
Active Duty Spouse
Reservist Spouse
Veteran Spouse
National Guard Spouse
With which branch of service are you currently associated?
Please select...
Navy
Marine Corps
Air Force
Army
Coast Guard
National Guard
Reserves
US Public Health Service/NOAA
Other: please specify
Are you separating or retiring?
Please select...
Separating
Retiring
What is your rank?
Please select...
E1
E2
E3
E4
E5
E6
E7
E8
E9
WO1
WO2
WO3
WO4
WO5
O1
O2
O3
O4
O5
O6
O7
O8
O9
Are you prior enlisted?
Please select...
Yes
No
What is your current or anticipated discharge status?
Please select...
Honorable
Other Than Honorable
General Under Honorable
Bad Conduct
Dishonorable
Prefer not to state
What is the month and year of your separation/retirement date from active duty? (MM/YYYY format only please)
(MM/YYYY)
What is your date of birth?
(DD/MM/YYYY)
What is your marital status?
Please select...
Not Married
Married
Divorced
Separated
Widowed
Prefer not to disclose
How many children do you have under the age of 18?
Please select...
0
1
2
3
4
5
What is your highest education level?
Please select...
Not yet high school
High School Diploma
Some College
Associates Degree
Bachelors Degree
Graduate Degree
Agree To Terms
Agree
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Terms of Use
Thank you for allowing zero8hundred to say more than just a "Thank You for Your Service." One of our staff will contact you after you schedule your Introductory Call.
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