455 Main Street, Worcester, MA, 01608, US
By filling out the application below you certify that you are the Veteran, family of a Veteran or someone legally appointed to act on behalf of the Veteran or family of a Veteran. You acknowledge that you are in need of financial assistance. The program you are applying for is NOT under the federal VA system; this is a benefit available only to residents of the Commonwealth of Massachusetts. By filling out this form, you acknowledge that you are a resident of the City of Worcester. If you do not live in Worcester, please contact your city or town hall to locate your Veterans' Service Officer (VSO). Once the form is completed and submitted, it will be sent to the Worcester Veterans' Services Office for review. You will be contacted by the Office to acknowledge receipt of your application and to let you know what paperwork will be required when you come in to complete your application.
*Information submitted in the following form is secure and will not be shared with anyone outside of the Veterans' Services Office.
Character of Service
Are you Married?
Do You Live Together?
Name of Spouse
Is Your Spouse Also a Veteran?
Do You Have Children (Biological or Legally Adopted)?
Do You Owe Child Support?
Do You Own an Automobile?
Do You Pay Rent or Own?
Is Heat Included?
Is There a Mortgage on the Property?
Type of Property
Do You Receive Rental Income?
Do You Have Fuel Assistance?
Tell Us About Your Income. Check All Boxes that Apply and the Amount You Receive in the Extra Fields that Will Display.
Is Medical Insurance Being Deducted from Your Retirement or Pension?
If on Social Security, Are You Paying for Medicare?
Do You Have Any Claims Pending (VA, SSA, Other)?
Tell Us About Your Spouse's Income. Check All Boxes that Apply and the Amount You Receive in the Extra Fields that Will Display.
Is Medical Insurance Being Deducted from Your Spouse's Retirement or Pension?
If Spouse on Social Security, Are They Paying for Medicare?
Does Your Spouse Have Any Claims Pending (VA, SSA, Other)?
Do You Have a Life Insurance Policy?
Do You Have Health Insurance?
Do You Have a Bank Account, Including Prepaid Debit Card Accounts (Direct Express, NetSpend, Green Dot, Etc.)?
Do You Have a Digital-Only Cash Exchange Account (PayPal, Venmo, Zelle, Cash App, Etc.)?
Do You Have Any Stocks, Bonds, IRAs, 401Ks, CDs or Money Markets?
Do You Have Any Lawsuits Pending?
Are You Able and Looking for Employment?
Have You Applied for SSI, SSDI or VA Benefits?
This information is collected to make sure everyone is treated fairly. Your answers are voluntary and will not affect eligibility or amount.
Special Situation (Check All That Apply)
Are You a US Citizen?