3702 Loop 322 • Abilene, TX 79602 • 325-672-8544

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Veteran Intake Form

Please enter as much information as you can.

MM slash DD slash YYYY
Type
MM slash DD slash YYYY
MM slash DD slash YYYY
Address
DD-214 in Possession?(Required)
Va Card in Possession?(Required)
Have you spoken to anyone in HUDVASH Program?

Please have the Following Documents Available:

  • DD-214
  • Sign HINQ Request
  • Social Security Card
  • Proof of Income/Social Security Benefits/VA Disability (Employment - last 3 months of pay stubs.)
  • Photo ID (Driver's License/State ID/VA Card/Passport/School ID/TDCJ/BOP)
  • Copy of your Lease
  • Copy of Eviction/Notice to Quit/Warning Letter
  • Disconnect Notice (Utilities)
  • Landlord Contact Info (Name of apartments/Property Col, Owner, address, & Tel. No.)

WEST CENTRAL TEXAS
COUNCIL OF GOVERNMENTS
3702 Loop 322
Abilene, TX 79602

325-672-8544

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PRIVACY POLICY
We are the sole owners of the information collected on this site. We only have access to/collect information that you voluntarily give us via email or other direct contact from you. We will not sell or rent this information to anyone. We will use your information to respond to you, regarding the reason you contacted us. We will not share your information with any third party outside of our organization, other than as necessary to fulfill your request for information. We take precautions to protect your information. If you submit sensitive information via the website, your information is protected both online and offline. Whenever we collect sensitive information online, that information is encrypted and transmitted to us in a secure way; however, we are not encrypting personal information that you supply to us.Offline, only employees who need the information to perform a specific job (for example, billing or customer service) are granted access to personally identifiable information. Any personally identifiable information is kept in a secure environment.

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