Magnolia Terrace Veterans Pre-Qualification Worksheet Name* First Last Email* Phone*What category are you?*VeteranVeteran with SpouseTwo Married VeteransSurviving SpouseNoneDid you serve in active duty for at least 90 days?*YesNoDid you serve at least one day during a period of wartime?*World War IIKoreaVietnamGulf WarNoneDo you have an other than dishonorable discharge?*YesNo External Forms Basic VA Pension Form (527-EZ) Form for Surviving Spouse (534-EZ) Examination for Housebound Status or Permanent Need for Aid and Attendance (A&A 21-2680) Authorization to Disclose Information to a 3rd Party (21-0845) Statement in Support of Claim (21-4138) Request Pertaining to Military Records (Standard Form 180) Request for Nursing Home Information in Connection with Claim for A&A (21-0779) Application for Accrued Amounts Due to a Deceased Beneficiary (21-601) Medical Expense Report (21P-8614)
