New Start Pathways · Veterans Programming
Still Standing Workshop
Sign-Up & Intake Form · 90–120 minute trauma-informed session
Form ID
SS-001
Rev. 2026
Please complete the sections that apply to you. Individuals, family members, VSO leaders, and facility staff may all use this form. All information is kept confidential and is used only to coordinate workshop placement, accommodations, and follow-up support.
01
Participant Information
Full Legal Name
Preferred Name / Call Sign
Date of Birth (MM/DD/YYYY)
Pronouns (Optional)
Phone
Email
Mailing Address
City / State / ZIP
02
Military Service
Branch of Service
Current Status
Years of Service
MOS / Rate / AFSC
Discharge Status (if applicable)
Service-Connected Disability % (Optional)
03
Workshop Preferences
Setting
Focus Area (select all that apply)
Preferred Date(s)
Preferred Time of Day
Estimated Group Size
Host Facility / Organization
04
Accommodations & Safety
Other accommodations, sensitivities, or things our team should know
05
Emergency & Support Contact
Contact Name
Relationship
Phone
Alternate Phone / Email
In Crisis Now? Veterans Crisis Line — Dial 988, then press 1. Text 838255 or chat at VeteransCrisisLine.net. Free, confidential, 24/7.
06
Referral & Coordination
Referred By
Referring Person / Organization
Their Phone or Email
Case Manager (if any)
07
Consent & Acknowledgment
Participant Signature
Date
Guardian / Authorized Signer (if applicable)
Date