Adult Veterans Placement Referral & Application
Use this form to apply or refer your client adult independent and transitional living program for male veterans. The Independent Living Program (ILP) helps male veterans who are experiencing homelessness or housing instability to become self-sufficient adults. 

If your client is 21+, is a veteran, has proof of their veteran status and has income (or will be financially sponsored),  please complete the application below. Completing this application does not guarantee placement at AmirCola New Beginnings, LLC.

The mission of AmirCola is to create a culture where those we serve can rebuild and thrive as they move forward in reaching their maximum potential. If you have any questions, feel free to email info@amircola.com
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Email *
Name and date of birth of potential resident *
Your Name, title and agency (if being referred)
Your Email *
Your Phone Number *
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