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* 1. What branch of the military did you serve in?

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* 2. What is your DD214 discharge status?  Please know that we are considering veterans with any discharge status; this is not a disqualifier for our scholarship program.

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* 3. Are you willing to share a copy of your DD214 with Veterans Care Network for purposes of verifying your military and discharge status within 30 days of submitting this application?  If so, please email it to info@veteranscarenet.com. 

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* 4. When was the last time you were treated by a doctor, either in a primary care, urgent or emergency room setting?

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* 5. Are you willing to participate in both pre and post program evaluations to determine personal success during the program?

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* 6. Are you willing to obtain medical services (at no cost to you) from a Veterans Care Network provider within the Detroit area to include lab work, physical evaluations and medication administration when needed at least every 2 months for a period no greater than 6 months?

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* 7. Would you need transportation in order to receive medical services within this program?  Please know that your answer will not disqualify you in any way from being considered for this scholarship program.

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* 8. Are you willing to sign a medical release to Veterans Care Network providing us access to use medical data collected through this program for purposes of future planning, programming and evaluation?

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* 9. Are you willing to sign a release to participate in social media posts, photos, press releases, and any other marketing avenues in order for Veterans Care Network to share this program and its successes with the public in consideration for future programming, marketing and funding opportunities?

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* 10. Please provide the following information so that we may contact you further if selected for the program.

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