test First Name * Last Name * Address * City * State * Zip * Best Contact Number * Secondary Contact Number Current Duty Status * Active Reserve Guard Veteran Retired Do you have a DD214 * Yes No Are you enrolled in VA Healthcare * Yes No Do you have transportation * Yes No Where are you currently living? * House Apartment Motel Shelter Have you ever owned a home? * Yes No Do you own or rent a home? * Yes No If renting, current rent How would you rate your credit? * Great Good Fair Poor Unknown Do you currently have a deposit account? * Credit Union Bank None Are you currently employed? * Full time Part Time Unemployed Unemployed w/ Income Do you have another source of income? (check all that apply) * Retirement Pension Comp VA Pen VA Comp Social Security None Total monthly income *
