Qualified Family Member If Applicable Veteran Spouse Disabled Veteran Spouse or Child under 18 100% Disabled Veteran Spouse 100% Disabled Veteran Parent 100% Disabled Veteran Child under 18 100% Disabled Veteran/Surviving Child over 18 attending school Surviving Spouse Surviving Unremarried Spouse (Line of Duty/100% SC) Surviving Parent or Child under 18 (Line of Duty/100% SC) Qualifying Family Member's First, Middle and Last Name Qualified Family Members of Registered Veteran (Sponsor) Contact Phone * Contact Preference Phone Email Postal Mail Mailing Address (if different) Do you need a copy of your (the veteran's) Discharge Paperwork (DD214)? * Veteran Branch of Service * Marine Corps Navy Army Air Force Coast Guard Veteran's Pay Rate * E-1 E-2 E-3 E-4 E-5 E-6 E-7 E-8 E-9 WO-1 CWO-2 CWO-3 CWO-4 CWO-5 O-1 O-2 O-3 O-4 O-5 O-6 O-7 0-8 O-9 O-10 Veteran's Final Combined VA Service-Connected Disability Rating No Service-Connected Rating Applied for Service-Connected Rating & Awaiting VA Response 0% Service-Connected Rating 10%-20% Service-Connected Rating 30% Service-Connected Rating or greater 100% DAVPRM Veteran's Current VA Education Entitlement Status: * Applies, Awaiting VA Response Currently Enrolled in VA Education Entitlements Expired or Exhausted VA Educational Entitlements Need Assistance Applying for VA Education Entitlements Veteran's Employment Status * Active Duty Reserve or National Guard Gainfully Employed Temporarily Employed Unemployed Student TDRL, PDRL, VA Unemployabilty Insurance, SSI Retired Is the Veteran Homeless? * No Yes Veteran is Deceased Do you need assistance filing Veteran's Claim with the VA or DoD
This includes discharge upgrades.
Has the Veteran ever been convicted of a felony? * If "Yes", please explain. Include the offense(s), date(s), time served, parole, and probation status: Veteran's End of Active Service: * Veteran's Character of Discharge: * Honorable Other than Honorable (OTH) General Bad Conduct (BCD) Dishonorable Please select the category you would like more information about: If you would like to volunteer to help us provide one of the services above, please leave details in the comment box below. Please include your Questions, Comments and/or Concerns. Would you like to be on our mailing list? (No Junk Mail)