Resource Partner Profile
Organization Name
Parent organization name, i.e., Easter Seals of Southern California (NOT Bob Hope Veterans Support Program)
Guidestar Weblink to Organization
If you haven't done so yet, please go to Guidestar.org and create your company profile then include the link here. If you are not a non-profit you may put your company website here.
Specific Program Name
Specific Program Name, i.e., Bob Hope Veterans Support Program. Organization's may have MORE than one program
Program Overview or Summary Statement
Get from website or Program Contact
Program Website Link
weblink to the Specific Program - NOT just the Organization's weblink, i.e., https://www.easterseals.com/southerncal/our-programs/military-veterans-services/
Program Local Address
Include street address, city, state and zip code
Geographic Scope of Program
Please select...
Local (San Diego only)
Regional (southern California only)
California only
National (any 2 or more states)
“Warm Hand-off” Contact Information
Primary Contact Name
This is internal information. If there is a preferred method of contact, please include that information in the TIPS portion of this form.
Primary Contact Title
If you don't know their title, just leave blank
Phone Number
If there is no specific contact, provide the general phone number here
Email
If there is no specific contact, provide the general email here
Service Needs
zero8hundred Pillar
Please select...
Government Benefits
Employment
Education
Health & Wellness
Housing
Financial Assistance
Legal Aid
Transportation
Food
Childcare
Utilities
Other Basic Needs
Social/Community Connections
Caregiver Support
Resource Navigation
You can select more than one pillar by holding down the CTRL button when selecting options
Government Benefits Subcategory
Please select...
VA
Unemployment (EDD)
Calvet
CA Dept of Social Services (CalWorks)
DoD
Medicaid/Medicare
Social Security
Employment Subcategory
Please select...
Internships/Apprenticeships
Career Coaching/Counseling
Entrepreneurship
Job Training
Job Placement
Networking Opportunities
Education Subcategory
Please select...
Undergraduate/Graduate Schools
Vocational Schools
Financial Aid
Education for Family Members
Health & Wellness Subcategory
Please select...
Health Insurance
Mental Health - Counseling
Mental Health - Clinical Care
Mental Health - Alternative Therapy
Mental Health - Substance Abuse
Primary Health & Wellness Care
Physical Therapy
Prescriptions/Pain Management
Medical Devices
Transportation to Medical Appointments
Service Animals
Couples/Family Retreats
Fitness Resources
Housing Subcategory
Please select...
Permanent Housing
Transitional Living
Temporary Housing/Shelters
Sober Living
Safe Lots
Financial Assistance Subcategory
Please select...
Direct/Emergency Assistance
Living Expense Assistance
Financial Counseling
Debt Relief
Tax Issues
Legal Aid Subcategory
Please select...
General Advice/Referral
Benefits Related ONLY
Discharge Status Upgrades ONLY
Transportation Subcategory
Please select...
Travel Vouchers (Bus/Train/Uber/Lyft)
Transportation to Medical Appointments
Vehicle Modifications/Repair/Ownership
Vehicle Insurance
Food Subcategory
Please select...
Food Pantries/Food Banks
CalFresh/SNAP
WIC
Utilities Subcategory
Please select...
Payment Assistance
Energy Savings Programs
Medical Baseline Modifications
Other Basic Needs Subcategory
Please select...
Clothing
Electronic Items
Furniture
Personal Care Items
Baby Items
Social/Community Connections
Subcategory
Please select...
Adaptive/Non-Adaptive Sports
Adaptive/Non-Adaptive Recreation
Singles Activities
Family Activities
Volunteerism
Peer Support
Speaking Opportunities
Mentoring Opportunities
Coaching/Leadership Opportunities
Faith Life Opportunities
Caregiver Subcategory
Please select...
Counseling
Peer Support
Strategies
Respite
Retreats
Resource Navigation Subcategory
Please select...
General Support Referrals
Medical Referrals
Eligibility
Population(s) Assisted
Please select...
Service member
Veteran
Active Duty Spouse
Gold Star Spouse
Veteran Spouse
Caregiver (non-spouse)
Active Duty Dependent
Gold Star Dependent
Veteran Dependent
Branch of Service(s) Served
Please select...
Navy
Marine Corps
Coast Guard
Army
Air Force
National Guard
Reserves
Space Force
Deployment History Requirement?
Please select...
No requirement
Currently Deployed
Pre-Deployment
Post-Deployment
Combat Requirement?
Please select...
No requirement
Previous/Current Combat Assignment
No Previous/Current Combat Assignment
Discharge Status Requirement?
Please select...
Currently Serving (No need to be discharged yet)
Honorable
General Under Honorable Acceptable
Other Than Honorable Acceptable
Bad Conduct Acceptable
Dishonorable Acceptable
Service History Requirement?
Please select...
No Requirement
Pre 9-11
Post 9-11
Both Pre and Post-911
Service Era Requirement?
Please select...
No requirement
Gulf War II (Post 9-11)
Gulf War I
Vietnam War
Korean War
WWII
WWI
Other
Service-Connected Disability Requirement?
No
Yes
% Disabled Requirement?
Under Review
0
10
20
30
40
50
60
70
80
90
100
TIPS
Any other eligibility or disqualifying factors not addressed above
Contact Information