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Service Ticket

By filling out this form, we will give you a callback shortly to help you with solutions. Regular call-back time is 48-72hours, but the call-back time may increase due to an increased volume of requests.



Point of Contact First Name:
Point of Contact Last Name:
Relation to Veteran:


Race/Ethnicity:
Hispanic/Latino:
Marital Status:
Currently Serving?:
Branch of Service:
Combat Veteran:
Dates Served From:
Date Served To:
Wartime Period:
Character of Discharge:
Transitioning Veteran?:
Service Related Disability Rating?:

Additional Comments:



Requested Services- Select All That Apply:

Disability Compensation:
Education Benefits:
Employment Assistance:
Financial Management:
Legal:
Caregiver:
Death Pension:
Dependent Indemnity Compensation (DIC):
Vehicle Repair Assistance:
Rent/Utility Assistance:
Request for Military Records:
Transportation:
Housing Assistance (Care Team):
Justice Involved Veteran Assistance (Car:
Rehabilitation Assistance (Care Team):
Other / I Don't Know:



By completing this form, I give permission for my data to be held in a third party database used by Harris County Veterns Services Department (VSD) and agree that the VSD may process personal data relating to me for personnel, administration and/or management purposes as required by law. I give my permission for my contact details to be made available to the VSD described above, and I agree with the statement above.

Data Liability Waiver Signature:

Harris County Veterans Services Department

2100 Travis Street, Suite 210
Houston, TX 77002

VSOInfo@vso.hctx.net
(281) 876-6600