Program application Please Fill Out Our Application: This Application is Due By July 20th For Our August 10th -August 17th Female Veteran Program. Please enable JavaScript in your browser to complete this form.Name: *FirstLastAddress: *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhone: *Email: *Birthdate *Height: *Weight: *Marital Status: *SingleMarriedDivorcedDo 'You Have Children? *YesNoBranch of Military: *ArmyMarinesNavyAir ForceCoast GuardNational GuardReservesList or Describe: MOS, AFSC, or NEC: *Please Provide VA Rating and Describe Injury: *Please List or Describe: Combat Service OEF, OIF, or Other *Provide Type of Discharge and Rank: E/O/W *Please Note if You Have Any of the Following: *Combat Infantry BadgeCombat Action BadgeCombat Action RibbonCombat Medical BadgePurple HeartList Interests and Activitites: *Are These Activities Limited By Your Physical or Mental State? If so, how? *What Stress Relieving Outlets Do You Have and How Often Do You Engage in Them? *Please List Physical, Mental or Allergic Concerns: *Please Tell Us About Your Family:What Challenges, If Any, Do You Find in Connecting With Your Family and/or General Support Network? *Describe Your Biggest Obstacles That You Struggle To Overcome: *What Do You Hope to Gain From The Serenity Ranch? *What Ways Have You Tried To Achieve These Goals Before Looking Into The Serenity Ranch? *Please List Any Other Veterans Programs Or Trips You Have Participated In: *What Are The Benefits You Have Gained From Any Prior Treatment? *Please Describe Your Current Pattern of Using Alcohol, Prescription Medicine and/or Street Drugs: *How Much of a Role Does Your Pattern of Use Play In Your Daily Life Right Now? *Please Describe Any Horse Experience You May Have:Special Requests:How Did You Hear About The Serenity Ranch? *Please Add anything Additional That You Would Like To Share:Please add up and fill in the number in the box. This is how we block spammers 😉 * = Submit