VetAssist New Client Application

VetAssist New Client Referral Form

PROSPECTIVE CLIENT INFORMATION

Address *
Address
City
State/Province
Zip/Postal
Check which applies *
WAR PERIOD SERVED *
If the veteran did not serve during wartime, the applicant WILL NOT qualify for the "Aid and Attendance pension. The VA defines wartime periods as follows: World War II: December 7, 1941 to December 31, 1946 Korean Conflict: June 27, 1950 to January 31, 1955 Vietnam Era: August 5, 1964 to May 7, 1975 Or served in the country of Vietnam February 28, 1961 to August 5, 1964 Persian Gulf War: August 2, 1990 to (date to be determined).
If applicant is a SURVIVING SPOUSE was applicant divorced from veteran at time of veteran's death?
If the answer to the above question is "yes" the applicant WILL NOT qualify for the "Aid and Attendance" pension.
Is applicant driving? *
Applicant needs help with: Check all that apply *
Is applicant currently receiving a VA pension or VA compensation? *