New Application PLEASE READ ALL INFORMATION AND ANSWER THE FOLLOWING QUESTIONS: The form is used to begin the vetting and verification process for services offered by Heart of a Mountain. Completion and submission of this application does not guarantee receipt of any services from Heart of a Mountain. This application must be submitted by a Veteran OR Active Duty Service Member of the U.S. Armed Forces, Active or Retired Law Enforcement Office, Active or Retired Fire Fighter, Gold Star Spouse, or an immediate family member (Spouse/Children) of any of these services. This application is intended only for safety and security needs within the home with the understanding that it also includes personal and professional development for the entire household. SAFETY AND SECURITY IMPROVEMENT EXAMPLES: Do all the doors and windows lock? Do all the lights inside/outside work properly? Do the electrical outlets function properly and safely? Do the toilets flush? Does the water run throughout the house? Are all ADA needs properly addressed? Is the external gates/fence sound? Are there trip hazards in the home? Any distraction that could potentially put the service member and their family at risk of feeling neither safe nor secure. WHAT THIS IS NOT FOR: We do not "remodel" or "rebuild," we only focus on immediate safety and security needs in order to create a conducive healing environment and then provide the necessary tools to begin growing personally and mutually as a core, family unit. We do not make improvements to intentionally increase value for resale. Our services and material are donated and volunteered by great patriots who seek to make the living space more comfortable and distraction-free as the family plans to continuously live in the home and make it their primary place for healing and growth. Heart of a Mountain currently only serves domiciles that are owned and occupied (even if still under mortgage) as the primary residence. This does not include rental properties, leases, STRs, LTRs, or any property that is not owned or currently occupied by the applicant. COACHING The Heart of what we do is create a conducive healing environment in order to move all members of the household from where they currently are, to where they would like to be in life and goals. HōM is centered around helping our warriors and their families pave the path forward and taking more positive approaches to life through the services of personal and professional development life-coaching. By applying for services from HōM, you are agreeing to committing to at least 12-weeks of coaching and development for all immediate family members within the home. If this is not something you and everyone involved are willing to commit to, then we would ask you to apply when all are in agreement and available for the process. AFTERCARE Part of our ongoing support for you and your family is that we ask that you all are willing to volunteer with HōM to give back and support others within your community. Volunteerism has proven psychological benefits and endorphin releases to help improve our own mental state. This is why we offer these opportunities - because it's good for you! Not all volunteer opportunities will have major physical requirements and even most will have a need for everyone to come out and support those in need. The turnout alone is enough to offer the encouragement and boost that these families and warriors need. HōM will continue to offer training and development classes and opportunities that our alumni will always be welcome to participate in. We ask that you be willing to sign up for and participate in these trainings and programs as often as possible. Heart of a Mountain is a program for those who are ready to take the next step and move forward. Not everyone is ready for coaching - yet. If you are currently in counseling or seeing a mental health professional, please continue to trust this process and allow your professional to finish their work with you. Check with them to ensure you and the members of your household are ready to take the step into coaching to ensure you are completing the necessary steps in the journey of healing. If you or someone within your household needs counseling or to speak with a mental health professional, please contact our mental health partner, North Star Counseling and Development Center at 719-985-8917. Do you understand HōM's requirements? *YesNoHas everyone in your household agreed to and have been cleared to begin the coaching process? *YesNo CONGRATULATIONS! Thank you for agreeing to HōM's process and being ready and willing to take this next step in your fantastic journey! Contact InformationPlease review all information to ensure it is as accurate as possible so we can contact you.First Name *Last Name *Date of Birth *Phone - Home *Phone - Cell *Email Address *Street Address *City *State/Province *ZIP *Marital Status *MarriedWidowedDivorcedSeparatedSingleCommon LawOtherAre you a Gold Star family member?YesNoWho lives in the home? *Service InformationPlease provide all information as accurately as possible to help us determine eligibility of services offered by HōM.Who is applying? *ChooseVeteranMilitary Service MemberLEOFire FighterSpouseGold Star SpouseImmediate Family MemberRetired Service MemberRetired LEORetired Fire FighterOther (describe below)If Other, Please Describe *Branch of Service *ArmyMarinesNavyAir ForceSpace ForceCoast GuardLEOFire ServicesOtherCheck all that applyOther Service *Description of Service *Please describe your service to include units, deployments and dates, department, firehouse, etc...Disability Rating *If not disabled or currently pending a decision, please enter "0"Description of Injuries *Please describe injuries and traumas received due to serviceDescribe current physical and mental health status *Please describe modalities and treatments that the Warrior has received or are currently receiving.Property InformationPlease offer as much information as possible for us to best determine how HōM can best assist you. Answer ALL questions as honestly and completely as possible so we can best understand your current situation.Do you own the property you currently reside in? *YesNoIs your property currently under a mortgage? *YesNoOtherMortgage Other Details *Please upload proof of ownership or bank statement showing current mortgage of property. *Choose FileNo file chosenDelete uploaded fileSafety and ADA *Please list all safety concerns you have within the home to include unmet ADA needs.Security *Please list all physical security needs within the home. This does not include a missing or non-operable security system. This is more in relation to the doors and windows needing to be secured properly, or the interior/exterior lights working, the property fence/gate is sound, etc.Greatest Distractions *What are the greatest distractions that you currently face within the home that seem to haunt you mentally on a daily basis?Other Projects? *What other projects do you need help with in the home? Is your garage cluttered? Do you have a room that needs to be cleared out or cleaned? Do you just need some help with the yard to make it more safe? Other...What are the factors? *What are the primary reasons you have not been able to address these needs within the home on your own? What is keeping you from achieving these goals?Final ChecksPlease answer all questions honestly and completely.The Result? *How will the services that HōM offers help you? What will you be able to achieve that you did not believe possible before? How will you use it to help others?Volunteer *YesNoIs everyone within the home willing to contribute to building up and supporting others within their community through volunteer opportunities offered by HōM? This does not always require physical labor, but also mental and emotional support of others who are also struggling within our community.Walk-Through *YesNoBased on determination of the selection board, an in-person walk-through will be required in order to conduct a site survey as well as an initial coaching interview. Do you agree to allowing HōM personnel to conduct this walk-through and interview?Proof Of Service *Choose FileNo file chosenDelete uploaded filePlease provide proof of service (i.e. DD-214, Current NCOER/OER, Service Record, etc...). PDF or Image files only.Certify *YesNoDo you certify that all the information you have provided is true and accurate to the best of your knowledge?Signature *Please type your full name certifying that you have completed this application as a request to Heart of a Mountain for services and that you understand that this is only the beginning of the application and selection process and does not guarantee receipt of services.Pages to DisplayStep Control SORRY! Based off of your answers, you are currently not eligible for services from Heart of a Mountain. Please remember: You or an immediate family member must be a Veteran, Service Member, LEO, or Fire Fighter in order to be eligible. You must own the property you live in (to include mortgaged property) and it must be your primary residence. You must not currently be in counseling and/or your counselor must clear you to begin the coaching process. We partner with local businesses, skilled workers, and volunteers to help you eliminate safety and security distractions within the home you currently reside in. We do not offer major home improvements or remodeling projects - just what you need to ensure you are living in a safe and secure environment. An in-person walkthrough with a professional contractor and a coach is required for determination of eligibility and decisions on work that can/needs to be done. Once you have received from HōM, one of the continued aspects of care is that all who have received are also willing to volunteer and give back to others within their community. If this is something that everyone within the household is willing to do, we can offer full services as this is a part of the complete package of HōM. We do not guarantee that we are the best solution for you and your family. We want to help as many folks as possible, but we are set up to help those who are ready for this next step in their journeys. We encourage you to keep working towards that place in your lives as well! You can do it! HTMLClick "Send Message" to finish.Send MessagePlease do not fill in this field.