Form

Complete this form to connect with the Marine For Life Network representative near you.

First Name:

Required.

Last Name:

Email address:

Required.

Phone Number:

DoD ID Number/EDIPI if applicable (found on military ID card):

If known, what city are you looking for resources and connections in?

Required.

Please provide a detailed description of how we can assist you:

Other:

Wounded Warrior: If you are seeking assistance with services related to a wound Illness or Injury during your service, contact the Sergeant Merlin German Wounded Warrior Call Center at 877-487-6299.

In accordance with the Privacy Act of 1974 (Public Law 93-579), this notice informs you of the purpose for collection of information on this form. Please read it before completing the form. AUTHORITY: 10 U.S.C. 5013; 10 U.S.C. 5041; MCO 1754.6C; E.O. 9397, as amended; and SORN M01754-4. PURPOSE: To provide transition assistance and sponsorship for Marines who honorably leave active service and return to civilian life. ROUTINE USES: Information will be accessed by Marine for Life Program officials and authorized personnel with a need-to-know to meet the purpose. Information may be disclosed to organizations authorized to provide services and resources under the Marine for Life Program. A complete list and explanation of the applicable routine uses are published in the authorizing SORN available at: https://dpcld.defense.gov/Privacy/SORNsIndex/DODwide-SORN-Article-View/Article/570629/m01754-4/. DISCLOSURE: Providing information on this form is voluntary, however, failure to provide the information will result in an inability to receive information about the resources you have requested. RECORD MANAGEMENT: This form shall be managed in accordance with record schedule 1000-34, “General Correspondence (Military Personnel)” of SECNAV M-5210.1.