Code of Support Foundation Logo                                                  Case Coordination Client Application

Thank you for reaching out to Code of Support Foundation. In order to better assist you, please fill out the following form to have an intake coordinator contact you. Please note that Code of Support Foundation is committed to protecting your privacy and information you provide will not be shared with third parties.

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Family Member Contact Information





Please enter your Service Rank if applicable







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Caregiver Contact Information





Please enter your Service Rank if applicable







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Veteran's Contact Information









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Veteran's Demographics

(Example, 4/25/2003)

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Veteran's Military Service Data




(Example, 4/25/2003)

(Example, 4/25/2003)



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Veteran's Health-Care




Veteran's Housing and Transportation


Veteran's Employment & Income

Initial Needs Request

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Have you received ANY help from other organizations? If so please list the organization and what services were provided.
1000 characters or less
Veteran's Documentation

For verification purposes, please upload the following documents.  If you are unable to upload at this time, you will be able to provide it to the intake coordinator.





Service Agreement


This is an agreement between You (client) and Code of Support Foundation.  It outlines the expectations, roles, and responsibilities between you and your coordinator throughout the service coordination process.  We are dedicated to making each of our clients’ experience with us as positive and productive as possible, but we can’t do it without you.  This is going to be a team effort.

Client agrees to the following responsibilities:

  • I will be honest and will provide accurate information to the best of my ability and knowledge.
  • I will actively participate and stay engaged throughout the coordination process.  For example: I will return phone calls and emails in a timely manner. 
  • I will work together with my coordinator to establish a plan going forward.
  • I will provide appropriate documentation as requested to facilitate assistance.  For example:
    • Proof of service - DD214 or LES
    • Disability statement letter from the Department of Veterans Affairs
    • Bills, eviction notice, etc.
  • I will make every effort to follow through with the resources my case coordinator provides  and report back the results in a timely manner. 
  • I will be respectful and courteous in all communications with my case coordinator(s).

Case Coordinator’s roles and responsibilities:

  • We will listen to you with respect and empathy.
  • We will help you prioritize your short/long term needs and goals.
  • We will identify and help you navigate the resources that can meet your needs to the best of our ability.
  • We are committed to protecting your privacy and only using your personal information for the purpose of coordinating support services.
  • We will maintain consistent and timely communication with you.


Our staff is deeply committed to getting you the help you and your family have earned through your service to our country.  However, we can’t do it without your cooperation.  Failure to adhere to the terms set forth above, may result in termination of case coordination services.  By checking the box below, you certify that you have read, understand, and agree to these terms.


Quality of Life Assessment