Veterans One-Stop Center of WNY, Inc.

1280 Main Street, Suite 204, Buffalo, NY 14209, (716) 898-0110

80 Professional Parkway, Lockport, NY 14094, (716) 898-0110

29 Liberty Street, Suite 207, Batavia, NY 14020, (585) 300-4604

Get to Know You Form

If you are a Veteran; currently serving in the Active, Reserve, or National Guard; a Caregiver, or a Military Family Member, completing this secure form will let us get to know you better and allow us to reach out quickly!
You can use it to have us contact you regarding a goal you have in achieving Housing Stability, Economic Success, or Emotional Health & Well-Being, or if you want to receive our newsletter to be connected with the great opportunities there are throughout WNY!
None of your information will be shared without your consent.
Please note that by sharing your email address you will be added to our mailing list. You will have an opportunity to remove yourself from this list if you do not wish to receive emails from our organization.
Someone will reach out to you within 2-4 business days.
Thank you for your service!

Name:*
Address:*
Phone:*
-
E-mail:*
Date of Birth (mm/dd/yy)*
Gender
Status:
Branch:
Component:
Rank:
Date Enlisted (mm/dd/yy):
Last Discharged (mm/dd/yy):
Combat Service:
Were you injured while on active duty status?:*
Were you injured on or after 11 SEPT 2001?:
Are you service-connected with the VA?:
Discharge Status:
Who are you linked with?:*
Are you currently enrolled in school or in a training program?:
VA Education Benefit Status:
Highest Education Completed:
Last School Attended/Currently Attending:
Employment Status: *
Housing Status:*
Transportation Status:*
I feel I am able to adapt when changes occur:*
I tend to bounce back after illness, injury, or hardship:*
I feel supported by the Veterans One-stop Center of WNY's holistic approach and my community resources:*
I am interested in: