Veteran Application Form

Veteran Application For Residency
Slate Belt Veterans Association
*Please note that the association maintains a list of qualified applicants arranged by date placement on the waitlist, which will govern the order in which placements are awarded. Initial occupancy can take place only after all regulatory approvals have been granted. Currently, that date is forecast to be May 2024.
Name

First NameLast Name
Are you disabled
Are you wheel-chair bound?
Are you a veteran with Honorable Discharge DD214 paperwork?
Do you own your own home?
Have you in the past, or currently reside within 50 miles of Bangor, PA?
If Yes, please provide your address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Phone Number
Please enter a valid phone number.
Should be Empty:

Veteran Application For Residency