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Mission and Need
Board of Directors
WHAT'S NEW AT OBHC?
In The News
Cabin Clips Newsletter, November, 2013
Cabin Clips Newsletter, June, 2014
Cabin Clips Newsletter, November, 2014
Cabin Clips Newsletter, May, 2015
Cabin Clips Newsletter, November, 2015
Cabin Clips Newsletter, June, 2016
Cabin Clips, November, 2016
IRS NON-PROFIT DETERMINATION
2011 FORM 990
2012 FORM 990
2013 Form 990
2014 Form 990
2015 Form 990
Fish Tales, BH 2-Fly Tournament
Chili Cookoff, 2014
Get The Word Out
"Operation Black Hills Cabin" APPLICATION
Who is qualified to apply:
Active Duty service members and Veterans who served in Operation Enduring Freedom; Operation Iraqi Freedom; or Operation New Dawn, who were Combat Injured at a minimum of 30%.
OR a Medal of Honor Recipient from OEF, OIF or OND.
OR Warrior Transition Unit (WTU) members. Include a copy of orders with the assignment to WTU, AND a signed statement from the applicant's primary physician on the physician's letterhead with the physician's contact information, and stating the member is pending a Statement of Disability with an anticipated rating of at least 30% due to Combat Injuries along with the type of disability.
This form can be filled in and submitted online, OR printed (right click on form to print) and mailed to us
with supporting documentation
to the address at the bottom of the application. No action will be taken on any submitted application until all supporting documentation has been received.
Please complete the following application in it's entirety.
Fully completed applications and supporting documentation will be reviewed on a first come, first served basis. Any lines left blank, or illegible, will lengthen the acceptance process, and may hinder your respite week. Please make sure all
required documentation is included.
CONFIDENTIALITY POLICY: All of your information is kept confidential. Operation Black Hills Cabin will not use, sell or disclose any information without your writt
Military member's name
Alternate Phone Number
Is military member Active Duty or Discharged
Who is military member's OEF/OIF/OND Case Manager
Which VA Health Care System is military member assigned to
Branch of Service
Military Member's Employer
Total number & names of people staying in the cabin (please include ages of children). This is an opportunity to reconnect with your immediate family as listed as dependents on your Award Letter, without the daily pressures of therapy, doctor appointments, etc. This is not the time to bring neighbors, friends, people not in your immediate family or individuals who are not caregivers, etc.
Family Interests & Activities
Please tell us about your family
Please provide a brief history of your military career
Please provide a brief detail of your combat related injuries
Please provide 3 personal references not related to you below: (Name, Phone, Address & Email)
Personal Reference 1
Personal Reference 2
Personal Reference 3
May we have permission to contact your references?
Will anyone staying in the cabin be using a wheelchair?
Does the service member have a Registered Assistive Service Animal that will be accompanying him/her?
If yes, please include with the application:
(1) A copy of the current Rabies Vaccination
(2) A signed statement from the service members OEF/OIF/OND Case Manager, or from their primary physician stating that the service member's needs include having a Registered Assistive Service Animal with them at all times.
(3) A copy of the graduation certificate from the appropriate Service Animal school.
Where did you find out about us?
Please list 3 dates of preference for the week you would like to stay in the cabin. A week is from Sunday at 3 pm (check in) to the following Saturday at 10 am (check out)
Please list any dates you CANNOT accept for your reconnection respite week.
Are you willing to accept dates during the months of May, August, September, or October?
If you are on a waiting list, and a week becomes available, what is the minimum amount of notice that would be acceptable to you to utilize an open week?
I understand that if we have additional people or unauthorized pets staying in the cabin or on the premises, we will be asked to leave immediately and will forfeit the remainder of our stay in the cabin. (Please sign below if you accept)
Send documentation to:
Operation Black Hills Cabin
PO Box 855
Custer, SD 57730
Include a copy of the service member's
current DD Form 214
as well as the
This is the letter from the VA showing the
breakdown of injuries
total disability percentage
as well as a
list of dependents. Only individuals listed as dependents on the Award Letter, or official caregiver (accompanied with official VA documentation), will be allowed to accompany the combat-injured veteran.
PLEASE NOTE: No action will be taken on any application submitted until we have received the required documentation as listed above. You may mail to the PO Box listed above, or scan and email the required documentation to email@example.com. No photographs will be accepted. All applications together with their required documentation will be reviewed on a first come first served basis. If all qualifications have been met, our next step will be contacting your references. With this process completed, we will then contact you to make further arrangements.
All travel expenses are your responsibility.
Feel free to contact us should you have any questions.
Operation Black Hills Cabin is a South Dakota 501(c)3 non-profit organization founded by a retired military couple.
Custer and the State of South Dakota have taken a very active part in OBHC, and this project is a way for us to say
for your service and sacrifice.