Victory Village, Inc. - VETERANS REGISTRY

Victory Village, Inc.
12408 Kennedy Flat Road
Jackson, CA 95642
ph: 209-223-2286
fax: 209-223-2297
info@victoryvillageamador.org

VICTORY VILLAGE, INC.
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VETERANS REGISTRY

Welcome to Victory Village Amador's Veterans Registry. Registration is free of charge and your information will be kept private.

VV Amador registration is used to determine your specific needs and assists us in creating a plan for case management.

*VETERANS FIRST NAME:

*VETERANS MIDDLE NAME:

*VETERANS LAST NAME:

Qualified Family Member

Qualifying Family Member's First, Middle, and Last Name:

Qualified Family Members of Registered Veteran (Sponsor)

Contact Email:

*Contact Phone:

Contact Preference:

Physical Address:

City:

*State/Province:

*ZIP/Postal Code:

*Country:

Mailing Address:

*Do you need a copy of your (the veterans) Discharge Paperwork (DD214)?

*Veterans Branch of Service:

*Veterans Pay Rate:

*Veterans Final Combined VA Service-Connected Disability Rating:

*Veterans Current VA Education Entitlement Status:

*Veterans Employment Status

*Is the Veteran Homeless:

Do you Need Assistance Filing Veterans Claim with the VA or DoD?

Please contact me.

This includes discharge upgrades

*Has the Veteran ever been Convicted of a Felony?

If "Yes" you have been convicted of a felony, please explain (offense(s), date(s), time served, parole, probation status:

*Veterans End of Active Service:

*Veterans Character of Discharge:

Please select the category you would like more information about:

Housing Employment Healthcare Assistance Education Training eBenefits My HealtheVet Peer to Peer Family Support Peer Coaching Substance Abuse Services

If you would like to volunteer to help us provide one of the services above, please leave details in the comment box below.

Questions, Comments, and/or Concerns:

Would you like to be on our mailing list (No junk mail)

Please add me to your mailing list

Submit Your Message:

We will contact you regarding your registration.
Thank you for your service to our country!

Website maintained by Victory Village Volunteer Staff

Victory Village, Inc.
12408 Kennedy Flat Road
Jackson, CA 95642
ph: 209-223-2286
fax: 209-223-2297
info@victoryvillageamador.org