• Veteran Outreach Form
• As a veteran, you may have earned benefits as a result of your military service. Spouses and dependents of veterans also may have benefits available to them. However, you must apply for your benefits to receive them. Your first step is to contact a Veterans Service Officer who can help determine your eligibility. Veterans Service Officers are available at the Oregon Department of Veterans’ Affairs and in every county in the state.
  
  Below is a form that is intended for use by military veterans, spouses and dependents seeking additional information about veterans’ benefits. Please do not submit private information, such as your Social Security number, birth date or personal information relating to your past, present or future physical or mental health condition. Submission of information confirms you agree with the ODVA Privacy Policy. Your information will be used to connect you with a Veterans Service Officer who will provide you information regarding your benefits.
  
• Name* First*  Last* 
• Address*
  Street Address* 
  Address Line 2 
  City* 
  State / Province / Region* 
  Postal / Zip Code* 
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• Email  
• Phone* (###)  - ###  - #### 
• Date* MM  / DD  / YYYY  Pick a date.
• Message/Comments 
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