Veteran Application Form Application Instructions: Before you begin, please verify that you meet the Program Requirements outlined below. Complete the application form below and submit. Incomplete forms will not be considered. For start-up business requests, please submit a business plan, budget, and goals. For equipment, vessels, vehicles, or other, please outline the intended use in the form below. Information (such as the DD-214, business plan, budget, and goals) can be emailed to This email address is being protected from spambots. You need JavaScript enabled to view it. or mailed to: Work Vessels for VetsPost Office Box 215West Mystic, CT 06388 Please Note: WVFV endeavors to assist as many veterans as is possible. Not all requests will necessarily be met, but will be kept on file as resources or matches may become available in the future. Recipients names and images may be used in future WVFV communications. Program Requirements: Honorable Discharge - You must upload a copy of your DD214 VA Disability Rating, if applicable – Please upload a copy of rating Interest in Self Employment – You must upload a Business Plan Statement of Need for Equipment for your business Next > Applicant Information Last Name(*) Invalid Input First Name(*) Invalid Input MI Invalid Input Address 1(*) Invalid Input Address 2 Invalid Input City(*) Invalid Input State(*) ConnecticutAlaskaAlabamaArkansasArizonaCaliforniaColoradoDistrict of ColumbiaDelawareFloridaGeorgiaHawaiiIowaIdahoIllinoisIndianaKansasKentuckyLouisianaMassachusettsMarylandMaineMichiganMinnesotaMissouriMississippiMontanaNorth CarolinaNorth DakotaNebraskaNew HampshireNew JerseyNew MexicoNevadaNew YorkOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVirginiaVermontWashingtonWisconsinWest VirginiaWyoming Invalid Input Zip(*) Invalid Input < PrevNext > Day Phone(*) Invalid Input Evening Phone Invalid Input E-mail(*) Invalid email address. Are you interested in Self Employment? Yes No Invalid Input If yes, please attach copy of Business Plan with Budget and Goals to this application. Invalid Input Upload your business plan, including answers to the following questions… A. What product or service are you selling? B. What were your revenues and profit from your business, before your compensation I the past 12 months? How many people are dependent on income from your business? C. Describe your competition. D. What experience do you have to develop and run this business? E. Why do you think your business will succeed? F. Explain why you believe you have the ability and know-how to deliver a quality product or service? < PrevNext > Employment / Education Status Are you in College or a Training Program? Yes No Invalid Input If yes, enter the name of the school. Invalid Input Have you Graduated? Yes No Invalid Input If yes, enter the degree earned. Invalid Input < PrevNext > Military Experience Branch Invalid Input Start Date Invalid Input End Date Invalid Input Rating/Rank at Discharge Invalid Input Do you have a service-connected disability rating? Yes No Invalid Input What percentage has the VA rated your disability? (10% - 100%) Invalid Input IMPORTANT: You MUST upload a copy of your DD214 Discharge paper. You may redact your SSN. DD214 Discharge Paper Invalid Input < PrevNext > Donation Request NOTE: Laptops for disabled veterans enrolled in Entrepreneurial Bootcamp for Veterans (EBV) at universities receive first priority. I am seeking donation of: Laptop Vessel Vehicle Tools Other Invalid Input If other, please describe. Invalid Input Utilization: If you were chosen to receive assistance from WVFV for what purpose would you utilize it? Invalid Input STATEMENT OF NEED Invalid Input < PrevNext > Signature You must check all of the following, then enter your Name and the current date. (*) I have an Honorable Discharge from Duty and have uploaded a copy of my DD214. Invalid Input (*) I have also uploaded a business plan, budget and goals for my start-up business idea. Invalid Input (*) I have outlined the equipment, vessel, vehicle or tools I am requesting and specified how the donation will be used. Invalid Input (*) I understand that not all requests will be fulfilled, and that my request may not be immediately available. Invalid Input (*) I further understand that my name and images may be used in future WVFV communications. Invalid Input (*) I certify that my answers are true and complete to the best of my knowledge. Invalid Input Your Signature NAME(*) Invalid Input DATE(*) Invalid Input PrevSubmit
