President Obama placing the wreath at the Tomb - Minnesota ...
President Obama placing the wreath at the Tomb - Minnesota ...
President Obama placing the wreath at the Tomb - Minnesota ...
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December 2009<br />
<strong>President</strong> <strong>Obama</strong> <strong>placing</strong> <strong>the</strong> <strong>wre<strong>at</strong>h</strong> <strong>at</strong> <strong>the</strong> <strong>Tomb</strong><br />
of <strong>the</strong> Unknown Soldier on<br />
Veterans Day – November 11, 2009
Continuing to Serve<br />
<strong>Minnesota</strong> Paralyzed<br />
Veterans of America<br />
One Veterans Drive<br />
SCI-238<br />
Minneapolis, MN 55417<br />
Monday - Thursday:<br />
8:00 AM - 4:00 PM<br />
Friday:<br />
8:00 AM - 1:30 PM<br />
Phone: 612-725-2263<br />
Toll Free: 1-800-663-6782<br />
Fax: 612-726-9472<br />
Email: mnpva@qwestoffice.net<br />
Executive Director<br />
Richard F. Jost<br />
Phone: 612-467-1651<br />
Email: rfjostmnpva@qwestoffice.net<br />
Officers<br />
<strong>President</strong> Charlie Wittwer<br />
Vice-<strong>President</strong> Russ Osborne<br />
Secretary Eric Webster<br />
Treasurer John Christensen<br />
Past <strong>President</strong> Eric Webster<br />
Board of Directors<br />
Leo Dondlinger – Todd Kemery<br />
Tom Fjerstad – Dave Langsdale<br />
Bill Frisby – Dave Hallis<br />
N<strong>at</strong>ional Director<br />
Thomas R. Fjerstad, PRP<br />
N<strong>at</strong>ional Service Offices<br />
Jason Stephenson – 612-629-7022<br />
Senior Benefits Advoc<strong>at</strong>e SCI-141<br />
Jim Arndt – 612-629-7021<br />
Voc<strong>at</strong>ional Rehab. Program SCI-139<br />
One Veterans Drive<br />
Minneapolis, MN 55417<br />
Tami Anderson – NSO II<br />
Federal Building Room 194B<br />
St. Paul, MN 55111<br />
612-970-5988<br />
1-800-795-3609<br />
FTS 612-970-5668<br />
Nor<strong>the</strong>rn Highlights Staff<br />
Editor Richard F. Jost<br />
Circul<strong>at</strong>ion Dianna Way<br />
Nor<strong>the</strong>rn Highlights<br />
Advertising R<strong>at</strong>es<br />
Please call <strong>the</strong> office for r<strong>at</strong>es.<br />
612-725-2263<br />
or<br />
1-800-663-6782<br />
The <strong>Minnesota</strong> Chapter of <strong>the</strong> Paralyzed Veterans of America is a non-profit organiz<strong>at</strong>ion.<br />
Our funding is primarily received from don<strong>at</strong>ions. The Paralyzed Veterans of America is<br />
<strong>the</strong> name of our parent organiz<strong>at</strong>ion, and is chartered by <strong>the</strong> Congress of <strong>the</strong> United St<strong>at</strong>es<br />
of America. All members of <strong>the</strong> Paralyzed Veterans of America, have sustained a spinal<br />
injury or disease. If you have any questions, or you would like to make a don<strong>at</strong>ion to our<br />
organiz<strong>at</strong>ion, please write to <strong>the</strong> address or call <strong>the</strong> numbers listed on this page<br />
Any and all articles th<strong>at</strong> appear in this newsletter, is <strong>the</strong> opinion of <strong>the</strong> author of<br />
said article, and not necessarily those of its members, Board of Directors, or th<strong>at</strong><br />
of this organiz<strong>at</strong>ion. Any advertising th<strong>at</strong> appears in this newsletter, is paid for by <strong>the</strong><br />
business or organiz<strong>at</strong>ion th<strong>at</strong> placed <strong>the</strong> advertisement. The <strong>Minnesota</strong> Paralyzed<br />
Veterans of America, by printing said advertisements, does not endorse and shall not<br />
be held liable for any claims of any kind against said business or organiz<strong>at</strong>ion.<br />
The <strong>Minnesota</strong> Paralyzed Veterans of America’s newsletter will be published<br />
12 times per year. The editor and/or assistant may edit all articles for content,<br />
grammar, clarity and punctu<strong>at</strong>ion.<br />
— Richard F. Jost, Editor.<br />
Wishing<br />
you a<br />
Happy,<br />
Healthy<br />
and Safe<br />
Holiday<br />
Season<br />
Table of Contents<br />
Volume 16, Issue 3<br />
Nor<strong>the</strong>rn Highlights<br />
<strong>President</strong>’s Report 3<br />
Executive Director’s Report 4<br />
Sr. Benefit Advoc<strong>at</strong>e’s Report 5<br />
Membership Report 5<br />
Government Rel<strong>at</strong>ions Dir. Report 6<br />
January Calendar & Schedule 7<br />
January Birthdays 8<br />
For Sale 8<br />
Member Applic<strong>at</strong>ion 9,10<br />
PVA Ad 11<br />
Spiritual Thoughts 11
<strong>President</strong>’s Report – Charlie Wittwer<br />
Hello everyone,<br />
As I look out my window and see snow on <strong>the</strong> ground, <strong>the</strong> bay iced over and a thin co<strong>at</strong> of ice on my van. Now being a<br />
college gradu<strong>at</strong>e and have acutely deduced th<strong>at</strong> winter is indeed here even though <strong>the</strong> calendar says it officially begins<br />
December 21st. So I guess we better put away <strong>the</strong> summer toys and replace <strong>the</strong>m with winter toys, (i.e.: snow blowers,<br />
shovels, snow machines, cross country skis, and anything else we can think of) but most if all we need warm clo<strong>the</strong>s to<br />
shield us from <strong>the</strong> winter woes th<strong>at</strong> are sure to come. I guess I better get down to business and let you know wh<strong>at</strong> has<br />
been going on.<br />
The main thing for me is my trip to Washington D.C. from November 10th-12th for <strong>the</strong> Veteran’s Day ceremony.<br />
Our Advocacy committee was <strong>the</strong>re which includes Tom Fjerstad, Todd Kemery and myself. It was a sobering and<br />
enlightening day with <strong>the</strong> event held <strong>at</strong> <strong>the</strong> <strong>Tomb</strong> of <strong>the</strong> Unknown Soldier. N<strong>at</strong>ional PVA was <strong>the</strong> host for this gre<strong>at</strong><br />
event. We witnessed <strong>President</strong> <strong>Obama</strong> and his very lovely wife, Michelle. We saw many dignitaries on <strong>the</strong> dias among<br />
<strong>the</strong>m, Chaplin Keith Ethridge, Directior, VA Chaplin Service, The Honorable Tammy Duckworth, Assistant Secretary,<br />
of Veteran Affairs, The Honorable Eric K. Shinseski Secretary of Veteran Affairs, and our very own Mr. Gene Crayton,<br />
N<strong>at</strong>ional <strong>President</strong> Paralyzed Veterans of America. The highlight of <strong>the</strong> ceremony was when <strong>President</strong> <strong>Obama</strong> laid <strong>the</strong><br />
<strong>wre<strong>at</strong>h</strong> on <strong>the</strong> <strong>Tomb</strong> of <strong>the</strong> Unknown Soldier. It was an exhilar<strong>at</strong>ing experience for all of us. I have never been to an event<br />
when <strong>the</strong>re were so many secret service people all over <strong>the</strong> place; you knew for sure something very noble was going on.<br />
Twenty-five organiz<strong>at</strong>ions were part of <strong>the</strong> planning committee th<strong>at</strong> organized this ceremony. The only glitch was <strong>the</strong> rain,<br />
but even th<strong>at</strong> did not stop <strong>the</strong> hundreds of veterans and civilians who were in <strong>at</strong>tendance. I was truly honored to be a<br />
part of this and hope to <strong>at</strong>tend in <strong>the</strong> years to come. The reception followed back of <strong>the</strong> Mayflower Hotel, in Washington<br />
D.C.; from1:00 to 4:00 p.m. and of course it was sponsored by N<strong>at</strong>ional PVA. It was a very special day all around and <strong>the</strong><br />
highlight of <strong>the</strong> reception was when we posed for a picture with Mr. Buzz Aldrin, <strong>the</strong> second man to walk on <strong>the</strong> moon<br />
which was taken by my lovely wife Jan who was with us <strong>the</strong> entire trip.<br />
Thank you for your time and remember to have fun and be kind!<br />
3
Executive Director’s Report – Richard Jost<br />
4<br />
By <strong>the</strong> time you read this we will have been visited by N<strong>at</strong>ional PVA<br />
PesidentGene Crayton (story follows) for a Voc<strong>at</strong>ional Rehabilit<strong>at</strong>ion<br />
celebr<strong>at</strong>ion on Tuesday December 1, 2009 th<strong>at</strong> Governor Tim Pawlenty,<br />
Minneapolis Mayor R.T. Rybak, Mike Pugliese Deputy Commissioner<br />
of Veterans Affairs of <strong>Minnesota</strong> along with many o<strong>the</strong>rs <strong>at</strong>tended.<br />
It was gre<strong>at</strong> to host <strong>President</strong> Crayton during his visit to <strong>the</strong><br />
Minneapolis SCI Center. W<strong>at</strong>ching <strong>the</strong> <strong>President</strong> work during<br />
his meetings with <strong>the</strong> SCI Director and Medical Center Director,<br />
I realized th<strong>at</strong> PVA is in very good hands with Gene Crayton as<br />
<strong>President</strong>.<br />
One of <strong>the</strong> reasons I am so very proud of this Minneapolis VA Medical<br />
Center is because of an article in <strong>the</strong> <strong>Minnesota</strong> Department of<br />
Veterans Affairs newsletter th<strong>at</strong> was received in <strong>the</strong> chapter office. The<br />
article I am referring to is as follows:<br />
“The Minneapolis VA Medical Center (VAMC) has joined a select group<br />
of organiz<strong>at</strong>ions th<strong>at</strong> have achieved a sustained level of excellence in<br />
performance as determined by <strong>the</strong> U.S. Department of Veterans Affairs.<br />
The Minneapolis VAMC is one of three recipients of <strong>the</strong> 2009 “Circle<br />
of Excellence” award, which was recently presented by <strong>the</strong> U.S. VA<br />
Deputy Secretary W. Scott Gould during a ceremony in Washington,<br />
D.C. Also honored were <strong>the</strong> Cooper<strong>at</strong>ive Studies Program Clinical<br />
Research Pharmacy <strong>the</strong> White River Junction VA Medical Center in<br />
Vermont.<br />
It was an honor to accept <strong>the</strong> “Circle of Excellence” award as this<br />
medical center continues in journey of continuous improvement,” said<br />
Minneapolis VAMC Director Steven Kleinglass. “This award honors<br />
every member of our staff who strives daily to serve our Veterans with<br />
first-class medical care.”<br />
The “Circle of Excellence” award recognizes organiz<strong>at</strong>ions (medical<br />
centers, benefits offices and cemeteries) within <strong>the</strong> U.S. VA th<strong>at</strong> have<br />
implemented management approaches th<strong>at</strong> result in sustained high<br />
levels of performance and service.<br />
Since 1992, <strong>the</strong> U.S. VA has recognized its departments with <strong>the</strong><br />
Robert W. Carey Quality Award.<br />
Each year <strong>the</strong> VA presents a Carey trophy award to <strong>at</strong> least one<br />
organiz<strong>at</strong>ion. Only recipients of <strong>the</strong> award during <strong>the</strong> previous five<br />
years are eligible for <strong>the</strong> “Circle of Excellence” recognition. The<br />
Minneapolis VAMC was <strong>the</strong> 2008 Carey trophy award winner.”<br />
The above article appeared in <strong>the</strong> Volume 3, Issue 12 of <strong>the</strong> <strong>Minnesota</strong><br />
Department of Veterans Affairs Newsletter d<strong>at</strong>ed December 2009.<br />
In closing I would like to wish everyone a safe, healthy and happy<br />
Holiday Season!!<br />
Live Life Laugh Daily Enjoy <strong>the</strong> Ride
Senior Benefit Advoc<strong>at</strong>e’s Report – Jason Stephenson<br />
ISSUANCE OF A SPORT MODEL WHEELCHAIR<br />
In accordance with VHA Directive 1173.06 Paragraph 4c, A Sports Model wheelchair may be considered for eligible<br />
VA beneficiaries who have a disability resulting in <strong>the</strong> an<strong>at</strong>omical loss, or loss of use, of <strong>at</strong> least one lower extremity<br />
which prohibits <strong>the</strong>ir particip<strong>at</strong>ion in normal sports activities. It must be determined th<strong>at</strong> <strong>the</strong> VA beneficiary is<br />
actively engaged in a sports activity which requires a specially designed sports wheelchair for <strong>at</strong>tainment of maximum<br />
rehabilit<strong>at</strong>ion. One sport model wheelchair may be furnished in addition to <strong>the</strong> veteran’s primary chair as well as<br />
back-up of equal value to a veteran who requires <strong>the</strong> continued use of a wheelchair for mobility. The request for a<br />
Sports Model wheelchair needs to be approved by <strong>the</strong> Major Medical Committee after a Physician who specializes in<br />
Rehabilit<strong>at</strong>ion medicine has entered a consult.<br />
Sports Model wheelchairs may be furnished to eligible veterans in lieu of a conventional type chair, even if <strong>the</strong> veteran is<br />
not actively engaged in a sports activity, provided <strong>the</strong> unique modific<strong>at</strong>ions in height, depth, and width contained in <strong>the</strong><br />
sport chair are appropri<strong>at</strong>e for <strong>the</strong> veteran’s physical condition and <strong>the</strong>re are no contraindic<strong>at</strong>ions for daily use.<br />
Replacement of a Sports Model wheelchair may not be authorized merely because a veteran desires a new model or type,<br />
or solely because a chair has been used for a particular length of time.<br />
If a veteran is interested in obtaining a Hand Cycle wheelchair, a Hand Cycle Wheelchair may be furnished but it will<br />
be furnished under <strong>the</strong> same provisions as st<strong>at</strong>ed above for Sports Model wheelchairs.<br />
If you have any questions regarding <strong>the</strong> issuance of a Hand Cycle wheelchair or a Sports Model wheelchair, please feel<br />
free to contact your Paralyzed Veterans of America N<strong>at</strong>ional Service Officer <strong>at</strong> ei<strong>the</strong>r 612-970-5668/1-800-795-3609 or<br />
<strong>at</strong> 612-629-7022.<br />
Also of note, in compliance with PVA N<strong>at</strong>ional Policy, both <strong>the</strong> PVA Regional Office and<br />
PVA SCI Office to include Voc Rehab office will be closed from December 24th through<br />
January 3rd. Jason, Tami, Elaine, and Jim want to wish everyone Happy Holidays and a<br />
Happy New Year.<br />
Membership Report – Dave Hallis<br />
Our current membership is <strong>at</strong> 340 with <strong>the</strong> breakdown as follows:<br />
Service Connected = 153<br />
Non Service Connected = 187<br />
Please keep in mind to enlist new members when you are out in <strong>the</strong> community because we would really like to see our<br />
membership increase. Veterans with a spinal cord injury or spinal cord disease with an honorable discharge from <strong>the</strong> military are<br />
eligible for membership into our chapter.<br />
The <strong>Minnesota</strong> PVA Chapter welcomes <strong>the</strong> following new members: Wayne McM<strong>at</strong>h and Lawrence Mullaly. We look forward to<br />
seeing both of you <strong>at</strong> our upcoming events. WELCOME!<br />
The MNPVA Chapter office received notific<strong>at</strong>ion th<strong>at</strong> MNPVA member Petro J Kmit has passed away. The chapter extends its<br />
deepest symp<strong>at</strong>hies to his family and friends during <strong>the</strong>ir time of sorrow.<br />
N<strong>at</strong>ional PVA notified <strong>the</strong> chapter office th<strong>at</strong> Walt Cable and Thomas J Shaughnessy have been placed on <strong>the</strong> undeliverable list.<br />
If any one knows how to contact <strong>the</strong>m please call <strong>the</strong> office so we can place <strong>the</strong>m back on our membership rouster again.<br />
5
Government Rel<strong>at</strong>ions Director’s Report – Thomas R. Fjerstad, PRP<br />
I was in Washington, DC for Veterans Day along with Chapter<br />
<strong>President</strong> Charlie Wittwer and Chapter Sports Director Todd<br />
Kemery. This was my ninth time in Washington for Veterans<br />
Day. Charlie, Todd and I <strong>at</strong>tended <strong>the</strong> ceremony <strong>at</strong> <strong>the</strong> <strong>Tomb</strong><br />
of <strong>the</strong> Unknowns in Arlington N<strong>at</strong>ional Cemetery. PVA was<br />
<strong>the</strong> official host for Veterans Day this year and our current<br />
N<strong>at</strong>ional <strong>President</strong> Mr. Gene Crayton delivered <strong>the</strong> speech <strong>at</strong><br />
<strong>the</strong> ceremony while se<strong>at</strong>ed next to <strong>President</strong> <strong>Obama</strong>. <strong>President</strong><br />
Crayton made PVA proud on a cold and rainy day in Arlington.<br />
The list of dignitaries in <strong>at</strong>tendance is too long to cover in its<br />
entirety but it included <strong>the</strong> First Lady, Vice <strong>President</strong> Biden and<br />
VA Secretary Shinseki.<br />
After <strong>the</strong> ceremony it was off to <strong>the</strong> reception <strong>at</strong> <strong>the</strong> Mayflower Hotel<br />
hosted by PVA. Secretary Shinseki spoke <strong>at</strong> <strong>the</strong> reception and a good<br />
time was had by all. <strong>President</strong> Wittwer, Todd, and I had our picture<br />
taken with Buzz Aldrin of Apollo 11 fame, <strong>the</strong> second man to set foot<br />
on <strong>the</strong> moon. I would like to thank <strong>the</strong> PVA N<strong>at</strong>ional staff involved<br />
with organizing a reception th<strong>at</strong> truly made PVA shine.<br />
On November 10th I was up on <strong>the</strong> hill visiting <strong>the</strong> offices of our<br />
elected represent<strong>at</strong>ives. I extended a personal invit<strong>at</strong>ion to <strong>the</strong><br />
reception <strong>at</strong> <strong>the</strong> Mayflower <strong>the</strong> next day and thanked <strong>the</strong>m for<br />
<strong>the</strong>ir support in <strong>the</strong> passage of advanced appropri<strong>at</strong>ions for <strong>the</strong><br />
Department of Veterans Affairs. On Thursday, October 22, 2009,<br />
<strong>President</strong> <strong>Obama</strong> signed H.R. 1016 into law. Public Law 111-81<br />
secures timely funding for veterans health care delivered through<br />
<strong>the</strong> Veterans Health Administr<strong>at</strong>ion. This was a huge victory for<br />
veterans. I received a present<strong>at</strong>ion on this concept in September<br />
of 2008 during a trip to Washington for a Chapter Government<br />
Rel<strong>at</strong>ions Directors meeting. The bill was introduced in<br />
February by Congressman Filner Chairman of <strong>the</strong> House<br />
Committee on Veterans Affairs. This <strong>the</strong>n became <strong>the</strong> number<br />
one initi<strong>at</strong>ive during <strong>the</strong> chapters visit to <strong>the</strong> hill in early March<br />
of this year. We be<strong>at</strong> our heads against <strong>the</strong> wall for many years<br />
over mand<strong>at</strong>ory funding and to have this bill signed into law<br />
eight months after it was introduced is absolutely astounding.<br />
On <strong>the</strong> local front our new office in <strong>the</strong> Veterans Building<br />
is nearly complete and will be fully oper<strong>at</strong>ional prior to <strong>the</strong><br />
start of <strong>the</strong> <strong>Minnesota</strong> Legisl<strong>at</strong>ive session <strong>at</strong> noon on Thursday<br />
February fourth. I was in <strong>at</strong>tendance <strong>at</strong> <strong>the</strong> UVLC meeting on<br />
November 4th. <strong>Minnesota</strong> Department of Veterans Affairs Deputy<br />
Commissioner Mike Pugliese requested organiz<strong>at</strong>ions share<br />
legisl<strong>at</strong>ive ideas for <strong>the</strong> upcoming session. I will be meeting and<br />
discussing ideas with <strong>President</strong> Wittwer and presenting those<br />
ideas to <strong>the</strong> chapter board <strong>at</strong> its December meeting.<br />
6
January 2010<br />
1 2<br />
3 4 5 6 7 8 9<br />
10 11 12 13 14 15 16<br />
17 18 19 20 21 22 23<br />
24 25 26 27 28 29 30<br />
31<br />
Office<br />
Closed<br />
Martin Lu<strong>the</strong>r King Day<br />
Schedule of Events<br />
December 21 Winter Begins<br />
December 24 Christmas Eve Day – Holiday Office Closed<br />
December 25 Christmas Day – Holiday – Office Closed<br />
December 26 Kwanza Begins<br />
December 31 New Year Eve Day – Holiday – Office Closed<br />
Office<br />
Closed<br />
New Years Day<br />
NOVEMBER 2009<br />
S M T W T F S<br />
1 2 3 4 5 6 7<br />
8 9 10 11 12 13 14<br />
15 16 17 18 19 20 21<br />
22 23 24 25 26 27 28<br />
29 30<br />
JANUARY 2010<br />
S M T W T F S<br />
1 2<br />
3 4 5 6 7 8 9<br />
10 11 12 13 14 15 16<br />
17 18 19 20 21 22 23<br />
24 25 26 27 28 29 30<br />
31<br />
January 1 New Year’s Day – Holiday – Office Closed<br />
January 18 Martin Lu<strong>the</strong>r King, Jr. Day – Holiday – Office Closed<br />
January 20 BOD Meeting<br />
Hospital Visit<strong>at</strong>ion: Monday through Friday<br />
Bowling South: Thursday mornings starting <strong>at</strong> 11:00 a.m. <strong>at</strong> <strong>the</strong> Eden Prairie Bowling Lanes in Eden Prairie, <strong>Minnesota</strong><br />
Bowling North: Thursday afternoons starting <strong>at</strong> 2:00 p.m. <strong>at</strong> Bowlers Advantage/Bunkie’s Bar & Grill Bowling Lanes in Chisago, <strong>Minnesota</strong><br />
Please call <strong>the</strong> MNPVA office if you plan on <strong>at</strong>tending any of <strong>the</strong> above activities <strong>at</strong><br />
612-725-2263 or 1-800-663-6782 or via email <strong>at</strong> mnpva@qwestoffice.net<br />
Birthstone: Garnet<br />
Flower: Carn<strong>at</strong>ion<br />
7
8<br />
January<br />
Birthdays<br />
1 Joseph R. Lanctot<br />
2 Harlan H. Ebert<br />
4 Edgar E. Traut<br />
Robert J. Young<br />
5 Lee M. Whitley<br />
7 Curtis L. Jorgenson<br />
Gordon G. VanKleek<br />
8 Michael W. McFarland<br />
Raymond A. Ostlund<br />
Philip N. Schmitz<br />
9 Donald O. Thompson<br />
12 Emmett N. Kuklock<br />
16 Mark G. Rahn<br />
23 Andrew J. Bernstrom<br />
26 Brian K. Olson<br />
Bill Wicklow<br />
27 Gary L. Hieronimus<br />
28 Mark P. Mimnaugh<br />
Roger H. Tottingham<br />
29 Robert L. Hawley<br />
Phillip J. Koehntop<br />
31 P<strong>at</strong>rick A. Donley<br />
Glenn D. Jackola<br />
FOR SALE:<br />
2006 Chrysler Town & Country Touring, Rollx<br />
conversion with infloor ramp, excellent condition,<br />
GPS, DVD lea<strong>the</strong>r, 32K, $26,000.00, for more<br />
inform<strong>at</strong>ion, please call 651-322-1277
PARALYZED VETERANS OF AMERICA<br />
MEMBERSHIP APPLICATION<br />
An individual is eligible for membership by meeting <strong>the</strong> following criteria: (1) is a citizen of <strong>the</strong> United St<strong>at</strong>es;<br />
(2) was regularly enlisted, inducted, or commissioned, and was accepted for or on active duty, in <strong>the</strong> Army, Navy,<br />
Marine Corps, Air Force, or Coast Guard of <strong>the</strong> United St<strong>at</strong>es or an ally of <strong>the</strong> United St<strong>at</strong>es; (3A) was separ<strong>at</strong>edfrom<br />
<strong>the</strong> service in <strong>the</strong> Armed Forces under conditions o<strong>the</strong>r than dishonorable; or (3B) is on active duty or must<br />
continue to serve after <strong>the</strong> cess<strong>at</strong>ion of hostilities; and (4) has suffered a spinal cord injury or disease (such as MS,<br />
ALS), whe<strong>the</strong>r or not service connected in origin. Membership is free. Complete and mail <strong>the</strong> applic<strong>at</strong>ion to:<br />
PVA Membership Department, 801 18th Street, NW, Washington, DC 20006 or to <strong>the</strong> chapter of choice.<br />
800-424-8200 • www.pva.org<br />
Chapter Name: _____________________________________________________________________________________<br />
First Name: ___________________________ Middle Initial: ________ Last Name: ____________________________<br />
D<strong>at</strong>e of Birth: _______ / _______ / _______ Social Security Number: _______________________________________<br />
Male Female Are you a United St<strong>at</strong>es citizen? Yes No<br />
Address: __________________________________________________________________________________________<br />
City: _________________________________ St<strong>at</strong>e: ___________________________ Zip: _______________________<br />
Home Phone: ______________________________________ O<strong>the</strong>r Phone: ______________________________________<br />
Email: _______________________________________________________________________________________________<br />
VETERAN STATUS INFORMATION<br />
DATE(S) OF<br />
MILITARY SERVICE<br />
Start D<strong>at</strong>e<br />
month/d<strong>at</strong>e/year<br />
<strong>Minnesota</strong> PVA Chapter<br />
month d<strong>at</strong>e year<br />
End D<strong>at</strong>e<br />
month/d<strong>at</strong>e/year<br />
TYPE OF<br />
SEPARATION<br />
Discharge (D) or<br />
Retirement (R)<br />
D or R<br />
D or R<br />
BRANCH OF SERVICE<br />
Army Air Force Navy Marine Corps Coast Guard<br />
Army Air Force Navy Marine Corps Coast Guard<br />
Have you ever been discharged under conditions th<strong>at</strong> are less than honorable? Yes No<br />
Is your spinal cord injury or spinal cord disease service connected? Yes No<br />
DISABILITY CLASSIFICATION<br />
SPINAL CORD INJURY<br />
(Complete ONLY if you have a traum<strong>at</strong>ic spinal cord injury)<br />
D<strong>at</strong>e of Injury: _______ / _______ / _______<br />
Injury Level: C1-C08 Cervical T01-T12 Thoracic<br />
Cause of SCI:<br />
L01-L05 Lumbar S01-S05 Sacral<br />
Vehicular (auto, motorcycle, aircraft, bicycle, etc.)<br />
Violence (gunshot, stabbing, explosion, etc.)<br />
Pedestrian (hit by car, etc.)<br />
Sport or recre<strong>at</strong>ion (swimming, diving, etc.)<br />
Flying or falling object<br />
Medical-surgical complic<strong>at</strong>ions<br />
O<strong>the</strong>r traum<strong>at</strong>ic injury ___________________________<br />
Unknown<br />
SPINAL CORD DISEASE<br />
(Complete ONLY if you have non-traum<strong>at</strong>ic spinal cord disease)<br />
D<strong>at</strong>e of diagnosis/onset of condition:<br />
_______ / _______ / _______<br />
Specific disease:<br />
Multiple Sclerosis<br />
Poliomyelitis<br />
Amyotrophic diseases (l<strong>at</strong>eral sclerosis, transverse myeltis)<br />
Syringomyelia<br />
O<strong>the</strong>r (specify) ________________________________<br />
9
LEVEL OF FUNCTION<br />
Indic<strong>at</strong>e your level of function:<br />
10 3/08<br />
Paraplegia Quadriplegia Hemiplegia No paralysis <strong>at</strong> this time<br />
GENERAL INFORMATION<br />
Please check <strong>the</strong> appropri<strong>at</strong>e box or fill in <strong>the</strong> blank of each of <strong>the</strong> c<strong>at</strong>egorical th<strong>at</strong> best describes your present st<strong>at</strong>us.<br />
This important inform<strong>at</strong>ion enables <strong>the</strong> PVA to compile d<strong>at</strong>a for <strong>the</strong> effective implement<strong>at</strong>ion and support of our programs.<br />
EDUCATION (highest level)<br />
Less than high school gradu<strong>at</strong>e<br />
High school gradu<strong>at</strong>e/GED<br />
Some college or trade school<br />
Associ<strong>at</strong>e’s degree<br />
Bachelor’s degree<br />
Attended gradu<strong>at</strong>e school<br />
Gradu<strong>at</strong>e degree<br />
O<strong>the</strong>r<br />
CURRENT EMPLOYMENT STATUS<br />
Employed full time<br />
Employed part time<br />
Self-employed<br />
Unemployed<br />
Unemployed due to disability<br />
Retired<br />
O<strong>the</strong>r ________________________<br />
MARITAL STATUS<br />
Divorced<br />
Married<br />
Never Married<br />
Separ<strong>at</strong>ed<br />
Widowed<br />
RACE/ETHNICITY<br />
Asian or Pacific Islander<br />
Black, not Hispanic/L<strong>at</strong>ino origin<br />
Hispanic/L<strong>at</strong>ino<br />
N<strong>at</strong>ive American or Alaskan N<strong>at</strong>ive<br />
White, not Hispanic/L<strong>at</strong>ino origin<br />
O<strong>the</strong>r ________________________<br />
TYPE OF RESIDENCE<br />
Apartment<br />
Assisted living facility<br />
Single-family home/condominium<br />
St<strong>at</strong>e/veterans retirement home<br />
Nursing home<br />
VA hospital<br />
VA nursing home<br />
O<strong>the</strong>r ________________________<br />
SOURCE(S) OF INCOME<br />
(check all th<strong>at</strong> apply)<br />
Employment<br />
Gifts/O<strong>the</strong>r<br />
Priv<strong>at</strong>e pension<br />
Social Security<br />
VA compens<strong>at</strong>ion<br />
VA pension<br />
Worker’s compens<strong>at</strong>ion<br />
NEXT OF KIN INFORMATION OTHER CONTACT INFORMATION<br />
Rel<strong>at</strong>ionship: ____________________________________<br />
(someone o<strong>the</strong>r than next of kin)<br />
Name: _________________________________________<br />
Rel<strong>at</strong>ionship: ____________________________________<br />
Same as member address on front of form<br />
Name: _________________________________________<br />
Address: _______________________________________<br />
Address: _______________________________________<br />
City: __________________________________________<br />
City: __________________________________________<br />
St<strong>at</strong>e: _______________________ Zip: ______________<br />
St<strong>at</strong>e: _______________________ Zip: ______________<br />
Phone: _________________________________________<br />
Phone: _________________________________________<br />
The Veterans Benefits Department advoc<strong>at</strong>es for quality health care for our members and can assist you to obtain <strong>the</strong> appropri<strong>at</strong>e<br />
benefits available as a result of your military service. Is PVA presently your benefits represent<strong>at</strong>ive? Yes No<br />
If yes, I have no objection and hereby permit PVA Service Officers to provide inform<strong>at</strong>ion to <strong>the</strong> PVA N<strong>at</strong>ional Membership<br />
Department th<strong>at</strong> pertains to my qualific<strong>at</strong>ions for membership.<br />
I declare th<strong>at</strong> I have read and meet <strong>the</strong> qualific<strong>at</strong>ions. I understand th<strong>at</strong> my<br />
membership could be revoked if any inform<strong>at</strong>ion provided is inaccur<strong>at</strong>e.<br />
Office Use Only<br />
D<strong>at</strong>e Received: ____________________________<br />
Applicant’s Sign<strong>at</strong>ure<br />
D<strong>at</strong>e<br />
Member ID#: ______________________________<br />
Processed D<strong>at</strong>e: ___________________________
Spiritual Thoughts<br />
Proverb 17:22<br />
A Cheerful heart is good medicine, but a<br />
crushed spirit dries up <strong>the</strong> bones<br />
11
1 Veterans Dr. SC1-238<br />
Minneapolis, <strong>Minnesota</strong> 55417<br />
First Name: ___________________________________________ MI: ___________________<br />
Last Name: __________________________________________________________________<br />
Address: ____________________________________________________________________<br />
___________________________________________________________________________<br />
City: ___________________________________ St<strong>at</strong>e: _____________ Zip: _____________<br />
Home Phone: ( ______ ) ____________________E-mail: ______________________________<br />
Birth D<strong>at</strong>e: _____/ ____ / ____ Membership ID Number ______________________________