Application Test Page - Oklahoma Department of Veterans Affairs

Name *

First

Last

Email *

Phone

Address *

Address Line 1

Address Line 2

City

State

Zip Code

County *

Religious Preference

Select one *

Date of Birth *

Race *

SSN *

VA Claim Number

Birthplace

(City & State)

Preferred First Name

Previous Occupation

Dropdown

If currently married, has veteran's spouse had prior marriages?

If yes, number of previous marriages

Date of Marriage

Place of Marriage

Name of Spouse

Type of Marriage

ex. ceremony, common, tribal

Reason for Termination

ex. death, divorce

Date of Termination

Place of Termination