Application

HAVE ALASKA PROGRAM APPLICATION

* Indicates required field

What program are you interested in? *

At this time, we are only accepting applications for veterans that are rated 50% or more (by VA) and who have been wounded in combat and have supporting documents proving a combat action device (CAR, CIB, Etc). Any questions or concerns, please email [email protected]

How did you hear about us? *

You understand by submitting any of your information or veterans information, you will then be contacted by a representative at HAVE Alaska to confirm and verify all information. Should you or your nominated veteran be selected, military service and eligibility will be verified by required documentation in order to be successfully added into the program. Do you consent to have HAVE Alaska contact you regarding this application?

Choose Any *

I consent to being contacted by the email provided.

Name *

First

Last

Date of Birth *

Phone Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Branch of Service *

Years Served *

Were you wounded in combat and have proof of combat action device? (CAR, CIB, etc.) *

Please explain how you were injured, type of injury and include injury date: *

Are you currently employed? *

Here at HAVE Alaska, we treat any disability with respect and understanding. Upon review, a disability percentage is taken into consideration. After submitting your questionnaire, it is sent to a HAVE Alaska team member for review. Prior to approval, we do require proof of service and discharge (DD-214) as well as a copy of your VA Rating determination letter. (Please understand that your information is confidential and only needed for verification for the company's protection.) Once received and approved, you will then be contacted by a HAVE Alaska representative to set-up a personal and confidential interview to get to know your needs a little better.
**By selecting your choice below, you agree that you have read and understand the Eligibility Process & Consent*

Eigibility *

I understand the eligibility process and consent.

Please upload required DD-214 *

Max file size: 20MB

Please upload required VA Rating Determination Letter *

Max file size: 20MB

If for whatever reason you are unable to successfully upload your information, please email [email protected] and title it: UNABLE TO UPLOAD FOR APPLICATION

Who are you and why do you need this program? *

If you were to be selected, how would it impact your life and those around you? *

What advice would you give your future self, 5 years from now? *

Submit