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VETERANS SIGN-UP FOR GETTING MENTORS
Required Required Question(s)
1.
Veterans Across America is offering unemployed and under-employed veterans the opportunity to be teamed up one-on-one with a "Champion Mentor," a business mentor who will make his/her network of contacts available to the veteran,  so that veteran job-seekers or entrepreneurs can follow smart "networking" leads and find their own paths to success. If you would like to be linked to a Champion Mentor, please fill out this form.  Thank you.

By entering my personal information, I consent to receive email communications from the survey author's organization based on the information collected.

First Name:
Last Name:
Company Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

2.
Sex
Male
Female
3.
Age
 

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Required 4.
Branch of Military Service?
 

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Required 5.
Years of Military Service?
 

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Required 6.
Military Occupational Specialty (MOS)?
 

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Required 7.
Final Military Rank?
 

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Required 8.
Wounded and/or Disabled?
Yes
No
  • Comment:

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9.
If wounded and/or disabled, please indicate % of VA disablity rating
 

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Required 10.
Employment status (Please check one)
Employed
Unemployed
Under-employed, working less than you'd like to
Other  
  • Comment:

  • 500 character(s) left.
11.
What industry or area of work would you like to join?
 

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12.
Marital Status?
Married
Divorced
Single
Other  
  • Comment:

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13.
Hometown? Town or City, State?
 

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14.
Name of your high school?
 

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15.
Your college?
 

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16.
Major area of study in college?
 

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17.
Your graduate school?
 

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Required 18.
Highest education degree attained?
 

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19.
Hobbies?
 

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20.
Sports you play, played or enjoy watching?
 

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21.
Favorite book or type of books?
 

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22.
Favorite movie or type of movie?
 

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23.

Favorite band or type of music?
 

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24.
Favorite Web-sites?
 

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Required 25.
Would you like to be teamed-up one-on-one with a Champion Mentor, to pursue employment or starting a business?
Yes
No
Other  
  • Comment:

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Required 26.
Would you like to attend a "Six Months to Success" employment conference/boot camp in your city or region?
Yes
No
Other  
  • Comment:

  • 500 character(s) left.