Military Personnel Resident Information Form

Full Name

First NameMiddle NameLast Name

Military Affiliation

Service Branch

Rank or Grade

Duty Status

Unit or Installation

Work Phone

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Current Residence Address

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Housing Type

Move-in Date

Date

Expected Duration of Stay (months)

Number of Occupants in Household

Residence Type

Special Housing Needs or Accessibility Requirements

Primary contact method

Emergency contact name

First NameMiddle NameLast Name

Emergency contact relationship

Emergency contact phone

Please enter a valid phone number.Format: (000) 000-0000.

Preferred contact time

Hour Minutes

AM/PM Option

Additional notes about assignment location changes, deployment-related absence, or housing updates