Your Name (required)

Your Email (required)

Address (required)

Address Line 2

City (required)

Zip Code (required)

State (required)

Phone (required)

Date of Birth (mm/dd/yyyy) (required)

Gender (required)

Branch (required)
Air ForceAir Force ReserveArmyArmy ReserveCoast GaurdMarine CorpsMarine Corps ReserveNational GaurdNavyNavy Reserve

Service Status (required)
DischargedRetiredTDRLPDRLPending Med BoardActive/Returning to Active

Rank (required)
E1E2E3E4E5E6E7E8E9O1O2O3O4O5O6O7O8O9O10W1W2W3W4W5

Type of Discharge (required)
Type of DischargeHonorableGeneral Under Honorable ConditionsAdministrativeGeneral Other Than Honorable ConditionsBad Conduct Discharge

Start of Service (mm/dd/yyyy) (required)

End of Service (mm/dd/yyyy) (required)

Date of Injury (mm/dd/yyyy) (required)

Type of Injury (required)
AmputeeBlindBurnPTSDSCITBISFW/GSWVision ImpairmentHearing ImpairmentOther (describe below)

Other Injury

VA Rating (required)
10%20%30%40%50%60%70%80%90%100%

Have you applied for VA benefits? (required) YesNo

Do you have a pending VA claim? (required) YesNo

Do you have a VA claim on appeal? (required) YesNo

Location of Hospitalization (required) First OptionSecond OptionThird Option

Have you applied for Social Security Income (SSI)? (required) YesNo

Have you applied for Social Security Disability (SSDI)? (required) YesNo

How did you learn about IATW? (required) FacebookWord of MouthNew ChannelWeb siteIATW EventGoogle SearchOther Social Media

Preferred Method of Communication (required) EmailPhone CallText MessagePostage

Eligibility of Service

As part of the verification process, we ask that you please submit a copy of either your (or, if a caregiver/family member, your warrior’s) DD 214 Service 2 or Member 4, VA Rating Decision Letter, Line of Duty (LOD) Documentation, MEB/PEB Narrative Summary, ERB or ORB document, or WTU orders. Please note: In order to upload the file at this time, it must be no larger than 4 MB.

If you are unable to attach the information at this time, you will receive an email after submitting your registration form with additional options for submission.

Upload Eligibility Document (required)