Rapid Response Referral Program – Intake Form

RRRP Case Management Intake Form - Production

Thank you for reaching out to IAVA’s Rapid Response Referral Program.  Below are our intake questions which will help us determine how we can best assist you.  If you would like to complete this intake over the phone instead of through this form, please contact your veteran transition manager and they will set up a time to speak on the phone.  All of your responses are confidential unless you express intent to harm yourself or someone else.  Thank you again for reaching out and we look forward to working with you.
Demographic Information

Your Military Information

Veteran - Service Details

Please write "Infantry" instead of 11B/0311, etc.

Your connection with the Department of Veteran Affairs

If you are reaching out on behalf of a veteran, please complete the following section with the veteran's information.

Please write "Infantry" instead of 11B/0311, etc.

Tell us about the veteran's connection with the Department of Veteran Affairs

Home, family and employment

What is the total amount of earned income for your household. This includes your spouse and working dependents.
Why are you reaching out to RRRP