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Unite New Jersey Veterans Assistance Request Form

New Jersey Veteran's

By completing the form below, you’ll be entered into our secure, coordinated network of community resources, powered by Unite Us, that is available to help. A member of the Unite Us Care Coordination team will contact you after you complete the form within 2 business days.

This form is not intended for emergent needs. For medical emergencies, please call 911 immediately.

Other Important Hotlines:

  • 988 – Suicide & Crisis Lifeline
  • 844-671-1019 – NJ DMAVA Veterans Services Hotline

Filling out this form means you’re asking to be connected to services in your area. Once completed, a staff member will contact you within two business days. The information you enter is completely confidential and there is no cost for this service.

Please use this form only to request services for yourself or a child (under 18 years old) or adult for whom you have legal guardianship. Consent submitted through this form should be signed by the person who would be receiving services or by their parent or legal guardian only.

Learn more about how we protect your information at https://uniteus.com/protect/.