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Veterans Affairs Contact Form

  1. Requestor Contact Information

  2. Veteran Contact Information

    Only fill out if this contact information is different than the requestor contact information listed above.

  3. Do you have your Military Discharge/DD214?*

  4. Character of discharge:*

  5. Who would you like us to contact?*

  6. How would you like us to contact you?*

  7. Please allow 48 hours for staff to follow up with you.

  8. Leave This Blank:

  9. This field is not part of the form submission.