Veterans’ Intake Application

VETERANS’ DATA

Contact People

Provide names, addresses and phone numbers of two family members or friends (not living with you) who will always know how to contact you
This form was one of many that were collected from service providers and is only intended to help program planners develop forms and tools that will serve the needs of their program.

BENEFITS INFORMATION

CERTIFICATION

I authorize 1st Veterans Kids Care, Inc. the ability to use and submit the information above and other records as may be necessary to the Veterans' Administration for use in counseling and supervising my benefits search, applications and determinations of eligible benefits.

1st Veterans Kids Care, a 501(c) (3) non-profit organization, was born out of a child’s act of kindness that touched a father’s heart.

Support

With enthusiastic employees and volunteers, we are ready to support you at any time.

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