REQUEST AN APPOINTMENT WITH THE VETERANS SERVICE OFFICER

Step 1 of 1

Please complete this form to send a message to and/or to request an appointment with the Kosciusko County Veterans Service Officer.

* Denotes a required field

Please Do Not Complete The Following Field

Full Name*

Phone*

Phone Area Code-Phone 3-Phone 4 ext Extension

Email Address*

Address*

City*

State*

ZIP*

Zip-Zip +4
Second portion of ZIP Code is optional.

Branch of Service*

Client Type*

Have you ever filed a VA claim before?*

Yes No

Do you currently have a claim or appeal pending?*

Yes No

Are you already service-connected for VA Disability?*

Yes No

If you are service-connected for VA disability, what is your total combined rating?

Are you homeless or at risk of becoming homeless?*

Yes No

How can we be of service to you? (Please be as specific as possible)*

Are you looking to gain access to specific benefits?

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