HEROES to HEROES BLUE: Officer Application
Please fill out the information below.
All applications will be kept confidential.
Heroes to Heroes Blue Foundation, a non-denominational 501(c)(3) organization, which provides a spiritual healing, suicide prevention, and peer support program for Police Officer's who suffer from Moral Injury and PTSD.
IL - Israel
Use format (xxx) xxx-xxxx
Law Enforcement Experience
Law Enforcement Agency
Years of Service
Less than a year
More than 20 years
Law Enforcement career status.
Is your department aware of your distress / issues?
Have you been involved in a Traumatic Event?
Have you been injured while on duty?
Date of Injury
If you have selected Yes in the Injured while on duty, please explain injuries.
Do you have a current U.S Passport
US Passort Number
If you answered yes to the question above please fill out the information below.
Name as it appears on Passport
Please type in you full name as it appears on your passport.
Passport Expiration Date
Passport Issue Date
Are you willing to work as part of a team for a minimum of 1 year?
Heroes to Heroes Blue Foundation requires a one year commitment to the team you will be traveling with. This may include monthly meeting in order to help one another meet individual goals and to complete a group project or goal.
Are you willing and able to comply with out "no-alcohol/drug" policy for the 10 day journey?
Are you able to travel on a flight for 12 hrs?
Have you visted Israel before?
Do you have a service animal?
Are you willing to submit a $500 deposit which will be returned immediately after journey?
Are there any special concerns or needs?
Please answer the questions below to the best of your knowledge. There are no wrong answers.
How did you hear about Heroes to Heroes Blue?
What do you know about Heroes to Heroes Blue?
What do you feel you will get out of a 10 day Journey to Israel?
What do you feel you can contribute to this program and your fellow Officer's
Any comments or concerns?
Upload a file
Please attach a photo of yourself.
You can upload multiple files.
By checking this box, you certify that all statements made herein are true and complete to the best of your knowledge and belief, and herewith apply for a grant to be part of the Heroes to Heroes Blue Foundation.
Send me a copy of my responses
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