Patriot application Home › Applications › Patriot application Patriot application DO NOT FILL OUT THIS FORM IF YOU HAVE DONE SO AT ANY TIME IN THE PAST unless instructed to do so by a member of our team. We retain records INDEFINITELY. Filling out this form more than once delays your application and those of other veterans, and increases the chances of errors in your application. Please do not use ALL CAPITAL LETTERS in your application. Doing so requires us to fix your entries manually, delaying your application and those of other veterans. Thank you! Your military service Branch of serviceArmyNavyMarinesAir ForceCoast Guard StatusActiveReserveInactive ReserveNational GuardVeteran (separated)Retired Years of service1-4 years5-9 years10-14 years15-19 years20+ years Mental health treatment Are you CURRENTLY receiving mental health treatment for any reason? Answering 'yes' does not disqualify you:Yes No Your pet adoption plans Pet preferenceDogCatDog or cat When do you plan to adopt?Soon as I'm approvedWithin the monthWithin the next 3 monthsWithin the next 6 months6 months or later What plans do you have in place if you are hospitalized, deployed or otherwise temporarily unable to care for your adopted pet? If your application is approved and you adopt a program-eligible pet, please let us know your preferred gift card:ChewyPetcoPetsmart Other ways to stay in touch Please provide a secondary contact, which will be used only if we are unable to reach you for an extended period of time during our routine follow up. DO NOT PUT YOURSELF as a secondary contact. Doing so will delay your application. First Name Last Name Phone ###-###-#### My secondary contact's email is the same as my emailYesNoMy secondary contact does not use email Email LEAVE THIS FIELD BLANK if you and this person use the same email address. Relationship to youSpouse or partnerAdult childSiblingOther relativeClergyHealth professionalNeighborOther If other, please specify relationship to you: How did we connect? How did you hear about Pets for Patriots?EventFacebookFriend or coworkerG+Health care professionalLocal shelter/rescue/animal controlMilitary, veteran organization or charitable organizationNews or articleOnline/internet searchOtherPets for Patriots adopterTwitter Anything else we should know about you? Almost done! By clicking the 'I AGREE' button below, I certify that all information provided by me is true and accurate, and that I have reviewed and accept Pets for Patriots' privacy policy and terms of use. I AGREE Contact Information TweetPinShareShare0 Shares
