Skip to main content

Application Test Page

First Name*

Last Name*

Email*

Phone

Address Line 1*

Address Line 2

City*

State*

Zip Code*

County*

Religious Preference

Select One* Male Female

Date of Birth*

Race*

SSN*

VA Claim Number

Birthplace (City & State)

Preferred First Name

Previous Occupation

Dropdown

If currently married, has veteran's spouse had prior marriages?

If currently married, has veteran's spouse had prior marriages? Yes No

If yes, number of previous marriages

Marriage 1

Date of Marriage

Place of Marriage

Name of Spouse

Type of Marriage (ex. ceremony, common, tribal)

Reason for Termination

Date of Termination

Place of Termination

Marriage 2

Date of Marriage

Place of Marriage

Name of Spouse

Type of Marriage (ex. ceremony, common, tribal)

Reason for Termination

Date of Termination

Place of Termination

Last Modified on Nov 23, 2020

Back to Top

Back to top

Oklahoma Department of Veteran Affairs
2132 NE 36th Street
Oklahoma City, OK 73111

Phone: Toll Free: 855-701-6382
Central Office Local: 405-523-4000

Contact Us

Copyright 2020 | Oklahoma Department of Veterans Affairs | All Rights Reserved ODVA is committed to facilitating the accessibility of its website. Please be aware that our efforts to ensure website accessibility are ongoing. If you have specific questions or concerns about the accessibility of any particular web page, please contact us.