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 Before requesting assistance, please fill out the VA Release of Information form listed below and submit it to the Vice President or Secretary emails. All information provided is strictly confidential and handled only through secure, official channels. 


Your privacy is very important to us. Your information is used only for the purposes of vetting and registration with the VA. It will not be sold, shared, or publicized in any capacity not explicitly required to render aid.


NO MEDICAL INFORMATION IS REQUIRED.

Please do not provide medical history as requested by the form. VA form is for vetting purposes only and will not be used for any medical purpose.



**IF YOU ARE ALREADY REGISTERED WITH THE PHOENIX VA**

Please submit a copy of your service connected VA card for verification.

VA Form 10-5345 (PDF)Download