Please complete one entry for each legal dependent of the applicant as a dependent physically residing in household at the time of application.

Please complete the monthly expense sheet to the best of your ability. Many items may not apply to your situation. A Housing Representative will work with you to complete the sheet upon submission of your application. The key is to be truthful and thorough.

In your own words, please explain specifically why you are requesting participation in VAREP's House-A-Vet Program.

Please include a brief summary of your military service and experience.

This is an opportunity to share your story with us.

The following information is requested by the Federal Government for certain types of reporting related to a dwelling in order to monitor compliance with equal opportunity, fair housing disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that an organization may not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, we may note the information on the basis of visual observation and surname if you have made this application in person. If you do not wish to furnish the information, please check the box below. Often our grantors and funding sources require ethnic information for demographic purposes. This is collected solely for that purpose and is not used for decision making.

To the best of my knowledge, I hereby certify that the information provided on this application is complete, accurate, and true. I agree and understand that by submitting this application I authorize VAREP to send me emails, newsletters, and customer satisfaction surveys.

I also agree to attend all required financial management workshops and continued education counseling sessions associated with my participation in VAREP's House-A-Vet program.