APPLY FOR SUPPORT

You Took the First Step

Asking for help takes courage. The Ezer Project exists to help veterans and their families explore a path toward healing, recovery, and restoration. If you or a veteran you love is struggling and looking for support, complete the confidential form below.

If you are completing this form on behalf of a veteran, you are welcome to apply as well.

Our team will review your information and reach out to learn more about your situation, answer questions, and discuss potential next steps. Everything you share is treated as confidential.

Tell Us About You

Full Name *

Preferred Name

Age

Phone Number

Email Address *

City and State

What is the best way to contact you?

Are you completing this application for yourself or someone else?

Military Service

Are you currently serving or have you previously served in the United States Armed Forces?

Branch of Service

Approximate Years of Service

Have you been deployed?

Recovery & Treatment

Are you currently looking for treatment related to substance use, trauma, mental health, or a combination of these?

Are you willing to travel for treatment if an appropriate program is available?

Do you currently have a strong support system at home?

Would you like your spouse or family to be involved in the recovery process when appropriate?

What would healing and recovery look like for you? *

Your Current Situation

How urgently are you seeking help?

Is there anything happening in your life right now that you believe our team should know about?

Financial Support

The Ezer Project works to help veterans access treatment and recovery resources that may otherwise be financially out of reach.

Would you need financial assistance in order to receive treatment?

Are you currently receiving VA benefits or other veteran assistance?

Is there anything you would like us to know about your financial circumstances?

Final Questions

Why do you feel now is the right time to pursue change? *

What is the most important thing you hope to get back in your life? *

Is there anything else you would like our team to know about you or your story?

Consent

I understand that submitting this application does not guarantee placement, treatment, financial assistance, or acceptance into a program.I understand that this form is intended to help the Ezer Project evaluate how it may be able to assist me and is not emergency medical care.I give permission for a representative of the Ezer Project to contact me using the information provided above.

What Happens Next?

Once your application is submitted, our team will review the information you provided and contact you to learn more about your circumstances.

Our mission is about more than simply getting someone into treatment. We want to help veterans pursue lasting recovery, rebuild relationships, reconnect with their spouses and children, strengthen their families, and rediscover purpose beyond their service.

You served when your country needed you. Now, when you need support, we want to be there for you.