Veterans Housing Benefits Application
Applicant Information
First Name
Last Name
Date of Birth
Social Security Number
Contact Details
Address
City
State
ZIP Code
Phone Number
Email
Military Service Information
Branch of Service
Service Dates
Discharge Status
Service Number
Household Information
Household Size
List of Dependents
Housing Needs
Housing Type Requested
Rental
Purchase
Assisted Living
Other
Preferred Location
Special Housing Needs
Income & Financial Information
Annual Household Income
Other Benefits Received
Authorization
I certify that the information provided is true and complete.