Northeast Ohio Foundation for Patriotism · NEOPAT's Adopt-A-Military Family Holiday Gift Giving Program Military/Veteran Registration

County *

Our non-profit charter is only able to service the 20 counties in Northeast Ohio. If you live outside of these counties, we regret that we will be unable to match you with a sponsor. Those counties are: Ashland, Ashtabula, Columbiana, Cuyahoga, Erie, Geauga, Holmes, Huron, Lake, Lorain, Trumbull, Mahoning, Medina, Ottowa, Portage, Richland, Sandusky, Stark, Summit, and Wayne.

Proof of Service *

We're required to demonstrate proof of service. Please upload a copy of your DD-214 or a current military I.D. or an LES. Just a picture of it works. You can feel confident knowing that you're protected by the privacy act and we do not share your document with anyone. Thank you for understanding.

How did you hear about this program? *

Military Service

Please answer a few quick questions about your military service

Military Branch *

Military Rank & Title *

Military Status *

Service Start Date *

(mm/dd/yyyy)

How long did you/family member serve? *

Your Household Family

It's important for us to know a little bit about your family so that we can provide the best experience possible!

Primary Contact Name *

First Name

Last Name

Primary Contact Email *

Verify Email *

Primary Contact Phone *

Number of People in Your Household 18 Years and Older *

Number of Children in Your Household *

Military/Veteran Address *

Address Line 1

Address Line 2

City

State/Province

ZIP/Postal Code

Military/Veteran Name *

First Name

Last Name

Military/Veteran Email *

Verify Email *

Military/Veteran Phone *

Military/Veteran Gender

Military/Veteran Birthdate

(mm/dd/yyyy)

Military/Veteran Wish List Ideas (If Clothing, please include sizes) *

Spouse/Partner Name

First Name

Last Name

Spouse Email

Verify Email

Spouse/Partner Gender

Spouse Birthdate

(mm/dd/yyyy)

Spouse/Partner Wish List Ideas (If Clothing, Please include sizes)

Child 1 Name *

First Name

Last Name

Child 1 Gender *

Child 1 Birthdate *

(mm/dd/yyyy)

Child 1 - Wish List Ideas/Themes (If clothing, please include sizes) *

Child 2 Name *

First Name

Last Name

Child 2 Gender *

Child 2 Birthdate *

(mm/dd/yyyy)

Child 2 - Wish List Ideas/Themes (If clothing, please include sizes) *

Child 3 Name *

First Name

Last Name

Child 3 Gender *

Child 3 Birthdate *

(mm/dd/yyyy)

Child 3 - Wish List Ideas/Themes (If clothing, please include sizes) *

Child 4 Name *

First Name

Last Name

Child 4 Gender *

Child 4 Birthdate *

(mm/dd/yyyy)

Child 4 - Wish List Ideas/Themes (If clothing, please include sizes) *

Child 5 Name *

First Name

Last Name

Child 5 Gender *

Child 5 Birthdate *

(mm/dd/yyyy)

Child 5 - Wish List Ideas/Themes (If clothing, please include sizes) *

Child 6 Name *

First Name

Last Name

Child 6 Gender *

Child 6 Birthdate *

(mm/dd/yyyy)

Child 6 - Wish List Ideas/Themes (If clothing, please include sizes) *

Child 7 Name *

First Name

Last Name

Child 7 Gender *

Child 7 Birthdate *

(mm/dd/yyyy)

Child 7 - Wish List Ideas/Themes (If clothing, please include sizes) *

OK to Meet? *

Our Sponsor Family will want to coordinate with you to deliver, drop off or meet with you at a public location to give you the gifts. Which of the below answers are best suited for you?

Tell us about your family!

Thank you. Tell us what ever you would like us to know about what makes your family unique. Perhaps it's a challenging situation, life change, or something to celebrate. Perhaps your favorite hobbies, interests, or what you do for a living. This is an open narrative to help us break the ice to get to know you when the sponsor family prepares their gifts for you.

Special Request?

Your Sponsor Family may wish make this Holiday Season super special! Do you have any reasonable special requests that we may be able to consider? We don't want to over promise, but we would like to know if we can consider something outside the box. If none, just put N/A.

Unique Accommodations?

Do you have any unique challenges or situations that require special support considerations? Accessibility, transportation, wheelchair, PTSD, TBI, or any other accommodation that we should know about? If you are supported by an Agency Case Worker, you can annotate their name and phone number here. We're more than happy to be flexible. If none, just put N/A.

All done!

Wonderful, thank you for sharing your information with us so that we can better understand how to have a positive impact on your holiday season. We will be in touch with a matching sponsor by early December. Please be patient with this step as we match civilian sponsors to military families based on a variety of criteria, particularly locations.