Please complete the form below and hit submit.  The Oklahoma Department of Veterans Affairs will be reaching out to you by phone upon submission of this application.

If you have questions or difficulties, please contact:
Shawn Kirkland
Director of Homes

Ph: 405-523-4007

APPLICATION FOR ADMISSION TO STATE VETERANS HOME (Updated 10/14/21)
ODVA Form #401 | Revised 10/2021 | Oklahoma Department of Veterans Affairs

VETERAN'S INFORMATION


VETERAN'S CENTER SELECTION

Select ONE

HIPAA POLICY

Please click to open the HIPAA Policy then check the box to acknowledge acceptance. (Opens in a new window)

Click to view the HIPAA Policy

SIGNATURE AND SUBMISSION

The Oklahoma Department of Veterans Affairs will be reaching out to you by phone upon submission of this application.

*** After hitting the Submit button, you should see a confirmation message. This page is slow to load due to form content. Thank you.