Apply to Purple Heart Motor Works

20150523-prostheticThe mission of Purple Heart Motor Works (PHMW) is to provide combat amputees and other seriously wounded combat veterans with a means to assimilate into mainstream society with dignity, through vocational training and employment in the automotive restoration industry. It is important to note that the work shop environment is an integral part of the rehabilitation of the military mindset. Mission first (car rebuild), second, cross train teams to work for mission completion, third and most importantly, provide for the interaction of wounded warriors with one another so that each one receives support, strength and encouragement to face the incredible challenges that life without a limb presents to each warrior.

Apply now to be part of this training program.

First Name (required)

Last Name (required)

Your Email (required)

Alternate Email

Address 1 (required)

Address 2

City (required)

State (required)

Zip (required)

Country (required)

Phone (required)

Cell Phone (required)

Date of Birth (format mm/dd/yy)

Gender:
malefemale

Branch of Service:

Service Status:

Rank:

Type of Discharge (if applicable)

Service Start Date (can be estimated) (format mm/dd/yy)

Service End Date (can be estimated) (format mm/dd/yy)

Injury Date (can be estimated) (format mm/dd/yy)

Type of Injury (check all that apply)
AmputeeBlindBurnPTSDSCITBISFW/GSWVision ImpairmentHearing ImpairmentOther (please describe below)

Other Injury Description

VA Rating (total rating - choose one)

Have you applied for VA benefits?
yesno

Do you have a VA claim pending?
yesno

Do you have a VA claim on appeal?
yesno

Hospitalization Location

Have you applied for Social Security Income (SSI)?
yesno

Have you applied for Social Security Disability (SSDI)?
yesno

How did you learn about PHMW?

How do you prefer to receive PHMW communications?

You will receive an email after submitting your registration form with request for documentation as described below.

As part of the verification process, we ask that you please submit a copy of either your DD 214 Service 2 or Member 4, VA Rating Decision Letter, Line of Duty (LOD) Documentation, MEB/PEB Narrative Summary, ERB or ORB document, or WTU orders.

If you do not have verification you may search for your records at the following link.
Search for Records