Veteran Status Verification Form
VSD-001
What is the veteran's name?
*
First Name
Middle Initial
Last Name
What is the veteran's Social Security Number (SSN)?
*
What is the veteran's Social Security Number (SSN)?
What is the veteran's sex?
Male
Female
Other
What is the veteran's date of birth (DOB)?
*
/
Month
/
Day
Year
Date Picker Icon
What is the veteran's primary language?
English
Spanish
Other
Where is the veteran's place of birth?
Where is the veteran's place of birth?
What is the veteran's drivers license number?
*
What is the veteran's drivers license number?
What is state issued the veteran's drivers license?
*
What is state issued the veteran's drivers license?
Are you currently receiving VA Compensation benefits?
Yes
No
If you are receiving compensation benefits from the VA, what is your VA combined disability rating?
If you are receiving compensation benefits from the VA, what is your VA combined disability rating?
What is the veteran's address?
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Veteran's phone number:
*
Please enter a valid phone number.
Format: (000) 000-0000.
Veteran's email
*
Confirmation Email
example@example.com
Please upload a copy of your DD-214 to verify your veteran status
*
Upload DD-214 (PDF File Only)
Drag and drop files here
Choose a file
PDF Files Only
Cancel
of
Please upload a copy of your Drivers License
Upload Driver's License (PDF File Only)
Drag and drop files here
Choose a file
PDF Files Only
Cancel
of
Submit
Should be Empty: