Apply for Assistance from Operation Injured Soldiers Foundation

INJURED SOLDIERS FOUNDATION

It is the VETERAN, not the preacher, who has given us freedom of religion.
It is the VETERAN, not the reporter, who has given us freedom of the press.
It is the VETERAN, not the poet, who has given us freedom of speech.
It is the VETERAN, not the campus organizer, who has given us freedom to
assemble.
It is the VETERAN, not the lawyer, who has given us the right to a fair trial.
It is the VETERAN, not the politician, who has given us the right to vote.

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GIVE US THE INFORMATION WE NEED TO HELP YOU.

You’ve reviewed the criteria, and you think you might be eligible. Now all that’s
left is filling out the simple online form below. Once submitted, we will verify
your information and contact you regarding your acceptance to the program.

Fields marked with an * are required.

*First Name

*Last Name

*Address

*City

*State

*Zipcode

*Phone

*Email

*Gender

*Branch of Service

*Rank

*Are you still on Active Duty?

Yes

No

*Date of Injury

Are You a Reservist?

Yes

No

Are You a Guardsman?

Yes

No

Disability Rating?

Date of Discharge?

Do You need a Wheelchair?

If yes, how often?

Yes

No

% of the time

*Do you have Traumatic Brain
Injury?

*Do you have hearing loss?

Yes

No

*Do you have vision loss?

*Do you have Post Traumatic Stress
Disorder?

Yes

No

*Have you had any experience that was so frightening, horrible, or upsetting
that, IN THE PAST MONTH, you...
Have had any nightmares about it or thought about it when you did not want
to?

Yes

No

Tried hard not to think about it or went out of your way to avoid situations
that remind you of it?

Yes

No

Were constantly on guard, watchful, or easily startled?

Yes

No

Felt numb or detached from others, activities, or your surroundings?

Yes

No

If you have answered yes to any one of the above questions please contact The
NATIONAL VETERANS FOUNDATION – toll free @ 888-777-4443 – Mon. – Fri.
0900 – 2100 hours. Also contact the VA’s PTSD information hotline at 802-296-6300.

What are your Injuries?