Form

Complete this form if you are looking to provide resources or information to transitioning Marines, Veteran Marines, and their families.

First Name:

Required.

Last Name:

Required.

Work Email Address:

Required.

Phone Number:

Organization Name:

Where are your services located?

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

What is your organization's website address?

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 enroll organizations wanting to provide services and resources into the Marine for Life Program and to make their information readily assessable to 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 transitioning Marines seeking 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 be utilized by the requesting agency as a resource. RECORD MANAGEMENT: This form shall be managed in accordance with record schedule 1000-34, “General Correspondence (Military Personnel)”of SECNAV M-5210.1.