SomerVet Registration Form

SomerVet Registration Form
Fill out the form below to be informed of veteran-related events and opportunities in the City of Somerville.
Are you a current, former, or prospective Somerville resident?

Current residentFormer residentProspective
What years did you live in Somerville?
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number

Area CodePhone Number
E-mail
We will not sell or spam your email address.
What best describes your age range?*
What is your gender identity?*
Branch or branches of service:*

ArmyNavyAir ForceMarinesCoast GuardArmy ReservesNavy ReservesMarine ReservesNational GuardAir National Guard
Service status:*

ActiveRetiredVeteranWidow/WidowerChild
Base or installation assigned:
Other base or installation:
Era(s) of service:*

World War II (1941-1946)Korea (1950-1955)Vietnam Era (1961-1975)Desert Storm (1990 - September 10, 2001)Iraq/Afghanistan (September 11, 2001 - Present)Peace Time (Any era not covered here)
Please describe the year range(s) of your service*
Would you describe yourself as any of the following?

Women Service Member/VeteranSenior VeteranDisabled VeteranLGBTQ VeteranStudent VeteranHomeless/At Risk Veteran
Do you currently receive services or assistance?

YesNo
Do you receive any of the following services or assistance?

Mass General Law Ch. 115VA Health CareVA Compensation & PensionSocial SecuritySocial Security DisabilityOther non-profit or social service agency assistance
Please describe the other non-profit or social service agency:
If you are in need of new or additional services or assistance, please specify below:
Which school(s) did you attend?
What best describes your employment status?*
Are you, or have you ever been, a City of Somerville employee?

YesNo
Which City department(s) were you employed with?

PoliceFireGovernmentDPWAdmin/other
Should be Empty: