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Veterans Online Application
Veterans Online Application

 

Please fill in all the required fields on the Intake Application. Once submitted, the Veterans Advocacy Clinic will review your application and contact you with further instructions. Please be advised that the Clinic accepts new cases based on availability, and wait times may vary. If you need immediate assistance, please let us know and we will help you find a local legal services provider.


Your Name







Your Address












Contact Information




Which of these methods is the best way to contact you? (Choose one)
Primary Phone
Alternate Phone
Email

Is the Veterans Advocacy Clinic permitted to leave a voice message stating that the clinic has called?
Yes No

Is the Clinic permitted to send you confidential communications via email?
Yes No

Additional Information Annual Household Income
$
 


Number of persons in household that you support


What is your employment status?
Employed(Full-time)
Employed(Part-time)
Retired
Not Employed/since when


Who is your employer?


Are you homeless?
Yes No

How did you hear about the Veterans Advocacy Clinic?
Friends
Newspaper Article
Internet Search
Other (Please specify below)


Service History Please list all of the military branches for which you served.
Please include dates of service for each branch listed.


Characterization of Discharge(s):


Were you medically separated/retired?
Yes No

Are you a combat veteran?
Yes No

If you are a combat veteran, when and in which conflict?


Have you served overseas?
Yes No

If you served overseas, where and when?


Legal Services Requested Please indicate the area(s) of legal service(s) you are seeking by checking the appropriate box(es):

Assistance with disability compensation from the Department of Veterans Affairs
(If you select this box, please complete the Disability Compensation section below)
Physical Evaluation Board (PEB) representation
(If you select this box, please complete the PEB section below)
Filing for a discharge upgrade
(If you select this box, please complete the Discharge Upgrade section below)
Other (Please specify below)


Disability Compensation Do you currently have a disability rating with the Department of Veterans Affairs (VA)?
Yes No

If so, what is your total percentage of disability?



Please list your current disabilities (acknowledged by the VA) with their percentage below:


Disability Claims For the claims with which you would like legal assistance, please provide the following information.





Have you received a diagnosis for this disability?
Yes No

Have you received treatment for this disability?
Yes No

Have you ever filed a claim for this disability with the VA?
Yes No

If you have filed a claim with the VA, when did you do so?


If you have filed a claim with the VA, what was the outcome?
I am still waiting for the VA to issue a decision
I was denied compensation and have filed an appeal
I received a rating decision, but I would like to file for an increase.
I was denied compensation and have not yet done anything.

Enter the date you were denied compensation:




Have you received a diagnosis for this disability?
Yes No

Have you received treatment for this disability?
Yes No

Have you ever filed a claim for this disability with the VA?
Yes No

If you have filed a claim with the VA, when did you do so?


If you have filed a claim with the VA, what was the outcome?
I am still waiting for the VA to issue a decision
I was denied compensation and have filed an appeal
I received a rating decision, but I would like to file for an increase.
I was denied compensation and have not yet done anything.

Enter the date you were denied compensation:




Have you received a diagnosis for this disability?
Yes No

Have you received treatment for this disability?
Yes No

Have you ever filed a claim for this disability with the VA?
Yes No

If you have filed a claim with the VA, when did you do so?


If you have filed a claim with the VA, what was the outcome?
I am still waiting for the VA to issue a decision
I was denied compensation and have filed an appeal
I received a rating decision, but I would like to file for an increase.
I was denied compensation and have not yet done anything.

Enter the date you were denied compensation:

Please use the space below to provide any additional information about your disability claims that you think is important for us to know when reviewing your application.


If you have access to your most recent VA rating decision documents, please feel free to upload digital copies (Microsoft Word or PDF files only).


Physical Evaluation Board (PEB) Representation If you are not seeking PEB representation, please skip this section. If you are seeking PEB representation, please use the space below to explain your situation. Which disabilities are being considered for your PEB, what are your concerns about your current PEB process, and where are you in the process of your PEB?


Discharge Upgrade If you are not seeking assistance filing a discharge upgrade, please skip this section. I you are seeking assistance filing a discharge upgrade, please use the space below to explain your situation. Why do you believe you should receive an upgraded discharge and where are you in the process of filing for this upgrade?


Other Legal Services If you are seeking legal assistance in any other area, please describe your situation below. Otherwise, please continue to the next section.


Terms And Conditions Please read the following terms and conditions carefully and acknowledge your understanding.

In seeking assistance from the Bob Parsons Veterans Advocacy Clinic at the University of Baltimore School of Law, I understand:

1. If my case is accepted, I will be represented by law students under the supervision of licensed attorneys;

2. The Bob Parsons Veterans Advocacy Clinic at the University of Baltimore School of Law does not represent every kind of case or every applicant, and that I must meet certain eligibility requirements - submitting this application does not guarantee that the Clinic will represent me;

3. The Bob Parsons Veterans Advocacy Clinic at the University of Baltimore School of Law is independent of the Department of Defense (DoD) and the Department of Veterans Affairs (VA) and will be representing my interests, not those of the DoD, VA, or the United States government;

4. Representation is free, but incidental costs such as administrative costs and filing fees will be my responsibility;

5. Prior to undertaking representation, the Bob Parsons Veterans Advocacy Clinic at the University of Baltimore School of Law will prepare an engagement letter, detailing the agreement with me explaining each party's responsibilities;

6. My case could be reassigned to another Clinic student at the clinic director's direction; and

7. I am not represented by the Bob Parsons Veterans Advocacy Clinic at the University of Baltimore School of Law until I actually meet with the Clinic and sign an engagement letter indicating that representation has begun.



Check the box below to acknowledge that you understand and accept the above terms and conditions.
Yes. I understand and accept the above terms and conditions

Date Picker

Have you ever received assistance with your claims?
No
Yes, I received help from an attorney
Yes, I received help from a Veteran Service Organization (VSO)
Yes, I received help from the Department of Veteran Services
Yes, I received help from a family member
Other (Please specify below)


If you received help from a Veteran Service Organization, what is the name of organization that assisted you?


Are you currently receiving help from any of the sources above?
Yes No


Click "Submit Application" to send your client application to the Veterans Advocacy Clinic.