The 2020 Stand Down was canceled due to COVID-19

Registration for the 2020 North Florida Stand Down

Personal Information:

First Name

Middle Name

Last Name

Phone

Email

Social Security Number

Date of Birth

Service Information:

Branch of Service

Dates of Service - From:

Dates of Service - To:

Did you serve in a combat zone?

Yes No

If yes, where?

VA Information:

Are you registered with the VA for health care services?

Yes No

If no, have you applied for services with the VA?

Yes No

Please check all benefits you are currently receiving from the VA:

Medical Financial Housing None

Stand Down Attendance:

Have you attended a Stand Down before?

Yes No

If yes, when and where?

Which days of the Stand Down do you plan to attend?

Friday, April 17 Saturday, April 18 Both days

Will you be bringing a spouse or guest to the Stand Down?

Yes No Unsure

If yes, please provide his/her name:

Will you be bringing a pet to the Stand Down?

Yes No Unsure

If yes, what kind?

Cat Dog

NOTE: Veterinary care (cats and dogs only) will be available on Saturday, April 18 and is limited to two pets per Veteran.

Housing Information:

Are you homeless?

Yes No

IF YES, PLEASE PROVIDE THE FOLLOWING INFORMATION SO THAT WE CAN BEST ASSIST YOU:

Where are you currently staying?

What are your immediate needs?

How long have you been homeless?

How long have you lived in Leon County?

Medical Needs:

Have you suffered
traumatic brain injury (TBI)?

Yes No

If yes,
was the TBI combat-related?

Yes No

Additional information (optional):

Mental Health Needs:

Please check all current or immediate needs:

Depression PTSD Military sexual trauma Other

Additional information (optional):

Legal Needs:

Please check all current or immediate needs:

Criminal Civil Child Support Other (describe below)

Brief description of legal matters

Additional information (optional):

Driver License:

Do you have a Florida Driver License?

Yes No

If yes, what is the license number?

Do you have a Florida ID card (looks similar to license)?

Yes No

If yes, what is the ID card number?

Is your Florida driver license currently valid?

Canceled Suspended Revoked I don't know

NOTE:

You can check your Florida driver license status by clicking here.

Do you need help getting a driver license?

Yes No

Please check this box to acknowledge that you have read and agree to the following:

PLEASE READ CAREFULLY!

By submitting this registration, I do hereby hold harmless and release from responsibility the Tallahassee Veterans Legal Collaborative (TVLC), the United States Department of Veterans Affairs (VA), and all support and service providers for any and all injury I may suffer as a result of my attendance at the North Florida Veterans Stand Down. I acknowledge that all information collected on this form is confidential and will be used only for the purposes of the Stand Down or to assist me with a need I identified herein or will identify.

Click the red bar below to submit your completed registration by email. If you provided an email address above, you will receive a confirmation of your registration.

The 2020 Stand Down was canceled due to COVID-19

Registration for the 2020 North Florida Stand Down

Personal Information:

Service Information:

VA Information:

Stand Down Attendance:

NOTE: Veterinary care (cats and dogs only) will be available on Saturday, April 18 and is limited to two pets per Veteran.

Housing Information:

IF YES, PLEASE PROVIDE THE FOLLOWING INFORMATION SO THAT WE CAN BEST ASSIST YOU:

Medical Needs:

Mental Health Needs:

Legal Needs:

Driver License:

NOTE:

You can check your Florida driver license status by clicking here.

Click here for printable PDF form