HEROES to HEROES BLUE: Agency Referral Application

Please fill out the information below.

All applications will be kept confidential.

"Heroes to Heroes Blue Foundation is a non-denominational 501(c)(3) organization, which provides spiritual healing and peer support for active and retired Law Enforcement officers who have experienced severe trauma while on the job and are on a path to self-destruction due to moral injury or PTSD."

If you are referring an Officer with your department, please provide your information below.

Format (First & Last name)

Your position with the department.

Use format (xxx) xxx-xxxx

Please provide a brief reason as to why you are referring the Officer to the Heroes to Heroes Blue program.

Please provide the Officer's information below.

Use format (xxx) xxx-xxxx

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