FOCUS Application

FOCUS Application - Part I

Please fill out all the information requested below. After the FMF Executive Director reviews Part I of your application, we will call you to discuss the next steps in the application process.

1.0 Personal Information

* = Required

Please enter your name exactly as it will appear on your ID at the airport.

First Name *

Middle Name

Last Name *

Preferred Name

Gender *

Street *

Apartment

City *

State *

Zip *

Date Of Birth (mm/dd/yyyy) *

Primary Phone # *

Secondary Phone #

When is the best time to reach you?

Email *

Marital Status *

Number of Children *

2.0 Military History:

Service Branch(es) *

USMC

USN

USA

USAF

USCG

DD-214 *

Enlisted Date (mm/yyyy) *

Discharge Date (mm/yyyy) *

Discharge Type *

Pay Grade *

MOS *

OIF/OEF *

Do you have a Combat Casualty Nurse (or "none") *

Please list other veteran-support programs you've attended (or "none") *

How did you hear about FMF FOCUS? Please include name, if possible. *

Why do you want to attend FOCUS? *