This is the Pre-Registration Form. Please fill in the following information and then click the Send button at the bottom.

Last Name Middle Name First Name

Did you serve in a war zone? Dates Served

Birthdate Birthplace Message Address

Message Phone Have you attended Stand Down before? Yes No Where?

When? Height Weight

Hair Color Eye Color Gender Male Female

Highest Grade Completed Usual Occupation

Last Wage

Date Last Employed? How Long Have You Been Homeless?