Thank You - Veterans Accession House

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

A single male Veteran within our service area (Northern California)
A Veteran of any era
Willing to engage in weekly case management
Willing to live in communal housing
Assessed as not meeting criteria for acute psychiatric or medical care

Please note that program eligibility is determined on a case by case basis. Meeting criteria for program eligibility does not guarantee a Veteran will be admitted to the program.

Step 1

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

PDF VERSION FOR DOWNLOAD

DOWNLOAD THE FORM

PICTURE VERSION FOR DOWNLOAD

Completed forms can be:

Emailed to admin@vahouse.org
Faxed to 925.822.3185
Mailed to 1820 Galindo Street Suite 210, Concord, CA 94520

step 2

Submit the below web application to us:

Step 1 of 2

Full Legal Name
First Middle Last
Preferred Name:*
Date of Birth:*
Phone Number:*
Email Address:*
City / State of Residence: (Please note: We are located in and serve Northern California):*
Gender Identity:*
- Male
- Female
- Non-Binary
- Other
- Prefer not to say

What type of services are you in need of?
- Legal Services
- Housing Services
- Both
Military Branch of Service:*
Date of Enlistment*
Date of Discharge*
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?:*