Multnomah County Veterans' Services Referral Form
Thank you for filling out this inquiry. Please include as much information as possible. You can expect follow-up contact from Multnomah County Veterans' Services within 3 business days. If you have any additional questions or concerns please feel free to contact us at 503-988-VETS (8387).
Note to case managers and service providers: if you are filling out this form on behalf of a client, you may enter your e-mail address in the first line to receive a copy of the completed form for your record. The client's e-mail address can be added at the end.
Claimant's Name (if not the veteran i.e. Widow)
Claimant's Preferred Method of Contact
Claimant's Phone Number or Email Address
Briefly explain the purpose for this inquiry (disability, pension, housing, etc.):
Veteran's Branch of Service (select all that apply)
Army National Guard
Air National Guard
Veteran's Era of Service (select all that apply)
World War II: Dec 7th, 1941-Dec 31st 1946
Korean Conflict: June 27th, 1950 - Jan 31st 1955
Vietnam Era: Feb 28th, 1961 - May 7th 1975
Gulf War/Global War on Terrorism: Aug 2nd, 1990- Present Day
Referring Agency or Individual
Portland State University
Portland Community College
Mount Hood Community College
Multnomah County Staff
Oregon Department of Veteran Affairs
Central City Concern
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