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NOTICE: 

Due to the increased need and rising demand for Boot Campaign’s individualized Health & Wellness Program as well as the daily changes to local and state restrictions due to COVID-19, responses may be delayed. Interested individuals are still encouraged to pre-register with the form below so that their application can be processed in the order received.
 
*THIS IS NOT A FINANCIAL ASSISTANCE/FINANCIAL RELIEF OR CRISIS-CENTERED PROGRAM*
**CRISIS INFORMATION**
If you are experiencing a crisis and are contemplating suicide, immediately call the VETERANS CRISIS LINE at 1-800-273-8255 and press 1 or text 838255. You can also find more information at www.veteranscrisisline.net. If you are attempting suicide, or have committed bodily harm to yourself or others, please dial 911 immediately.  

If at the time of your application we are led to believe you are in a crisis situation we will immediately follow our crisis protocol.
MILITARY MEMBER'S PERSONAL INFORMATION













BACKGROUND INFORMATION











HEALTH AND WELLNESS INFORMATION

If you are not seeking services for one or more of these concerns, please do not submit this application.




CONFIRMATION



*Disclaimer: Boot Campaign does not discriminate on the basis of race, color, national origin, creed, 

marital status, sex, disability, age, gender identity, or sexual orientation in our organization's activities, 

including the grant process.