Apply - Veterans Accession House

Apply For Services

VA House is ready to help you. To access our legal or housing services,
please complete the application to get started on the support you need.

In order to be eligible for the VAH program, you must be:

be homeless or at risk of homelessness

a veteran within the Bay Area (Northern California)

a veteran of any era

discharge other than dishonorable

willing to engage in case management

Application To Apply For Services

Must Complete Step 1 and Step 2

Please note that program eligibility is determined on a case-by-case basis. Meeting criteria for program eligibility does not guarantee acceptance into the program.

Step 1

Submit the below web application to us:

Step 1 of 2

What type of services are you in need of?*
- Housing Services
- Legal Services
- Both (Housing & Legal)
Full Legal Name*
First Middle Last
Preferred Name:*
Date of Birth:*
Month
Day
Year
Phone Number:*
Email Address:*
City / State of Residence: (Please note: We are located in and serve Northern California):*
Gender Identity:*
- Male
- Female
- Prefer not to say

Military Branch of Service:*
Date of Enlistment*
Month
Day
Year
Date of Discharge*
Month
Day
Year
Type of Discharge:*
Awarded Service-Connected Disability?
Source of Income:
Last Four of SSN:*
Form of Medical Coverage:*
Are you receiving any medical treatment or experiencing any medical issues?:*
What do you hope to accomplish during your stay? What, where, when, how and why? Explain:*
If accepted into VAH, I understand I will be held to my purpose; will accept supportive aid and take immediate steps to accomplish my goals.*
- If accepted into VAH, I understand I will be held to my purpose; will accept supportive aid and take immediate steps to accomplish my goals.
CAPTCHA
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Understanding the mission and goals of the Veterans Accession House (VAH), explain why you are interested in VAH, instead of another traditional transitional housing program?:*
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Are you currently employed? Please explain your employment situation:*
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Are you attending a trade school or institution of higher education?*
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Are you receiving or in need of any supportive medical/ counseling services?:*

Step 2

Please print, sign & return the Department of Veterans Affairs Health Release Form

PDF VERSION FOR DOWNLOAD

DOWNLOAD THE FORM

Completed forms can be:

Emailed to admin@vahouse.org
Faxed to 925.822.3185
Mailed to 1820 Galindo Street #2B, Concord, CA 94520