Veteran & First Responder Program - Participant Registration

Thank you for applying to the Higher Ground Veteran & First Responder Program. We strive to ask only the questions we need to best serve you. If you have questions or would like assistance, email dave@highergroundusa.org or call 208-721-3067.

Basic Information
Mailing Address
Include Apartment # and multiple lines of addresses (if necessary)
Physical Address
Include Apartment # and multiple lines of addresses (if necessary)
Contact Information
Demographics
Do you think of yourself as (please select one).
Please select one or more of the following which you feel best describes you. (Hold CTRL + click to select multiple.)
Do you think of yourself as (please select one).
Service Information
First Responder Information
In which of the following areas have you worked? (Check all that apply)
Military Information
In which branch of the US military have you served? (Check all that apply)
Did you serve in a
Combat or War Zone?
Medical & Therapeutic Information
Do you have symptoms of any of the following? (Check all that apply)




To select multiple options, click and hold the Ctrl key while selecting all options that apply



Hidden Fields
DD Form 214
In addition to this application, we require all potential participants to provide a copy of their most recent Certificate of Release or Discharge from Active Duty; more commonly referred to as your DD FORM 214. When you were discharged from the Service you should have received two copies of the DD FORM 214 – a short form and a long form. The long form includes the type of separation (block 23), character of service (block 24), separation code (block 26), reentry code (block 27), and a narrative reason for separation (block29). In the lower left hand corner of the long form you should see DD FORM 214 and in lower right hand corner you should see Member–4. This is the copy that we are asking you to send us.

You can submit the DD FORM 214 at a later date, however you must send it to us prior to participating in Higher Ground Veteran Programs.

Contact Information