Public Notice

Our MAIN OFFICE 3950 Chester Ave, Cleveland Is Now OPEN!

Our satellite Offices at Wade PARK & PArma CBOC are no longer OPEN FOR SERVICE!

Help us Serve you better & Take the “Veterans Voices Matter” Survey HERE

Our offices will be closed March 13, 2026 for staff training

Veterans/Dependents are encouraged to call 216-698-2600 Or Walk-in

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Form Name:

Release of Information Form

Investigator Name:

Christopher Williams

Click below to preview the form.

VSC Application - Cuyahoga County - Intake Form

"*" indicates required fields

Name*

First Last Suffix

Email Address*

Phone*

Preferred form of contact

Email

Phone

Assistance Guidelines

Assistance will be given only to those veterans (“Veteran” as defined by Ohio Revised Code) who have a documented emergency, as determined by the Veterans Service Commission, and who are otherwise eligible under the Ohio Revised Code, Section 5901(B).

If all the requirements are met for emergency assistance, you would be eligible for no more than (9) assists in 36 months.

No assistance will be provided unless all requested documentation is supplied. No assistance beyond the guidelines will be available without documented Extenuating Circumstances and the approval of the Commission’s Director’s and or the Board of Commissioners.

The Cuyahoga County VSC takes each emergency request very seriously and we strive to complete your request in the fastest most efficient process.

No cash assistance will be given. All Financial Assistance will be made by Auditor’s Voucher directly to the Landlord, Lending Institution, or Vendor.

Lost Food cards will not be replaced. A valid, Photo ID must be presented before any assistance is given. Failure to follow the directions of the Board of the Cuyahoga County Veterans Service Commission or its representatives, failure to provide proper documentation, refusal to sign forms requested, or failure to participate in any counseling plan that has been agreed to will result in the denial of any future assistance. By signing below, the applicant acknowledges understanding of these Guidelines and further acknowledges that any form of fraud or misrepresentation that might be uncovered during the course of the investigation of the application for Financial Assistance or any misuse of funds or food provided by the Veterans Service Commission will result in denial of all future requests for assistance until such time as those sums that were fraudulently obtained are repaid to the Cuyahoga County General Fund.

Applicant Signature*

Date Signed*

Month

Day

Year

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Financial Assistance Application/Statistical Data Sheet

This application must be completed by answering all questions.

(Note: Disclosure of Social Security account numbers is voluntary, but failure to provide such information may affect your application for financial assistance. Social Security numbers are used as secondary identifiers to determine an applicant’s eligibility for assistance.)

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Date*

Month

Day

Year

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Last name*

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First name*

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MI*

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SSN

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Date of Birth*

Month

Day

Year

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Date of Death

Month

Day

Year

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Marital Status*

Note: Common law marriages are recognized in Ohio only if they were established prior to October 10, 1991.

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Date of Marriage

Month

Day

Year

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Date of Divorce / Separation

Month

Day

Year

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Spouse (maiden name if applicable)

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Spouse SSN

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Spouse Date of Birth

Month

Day

Year

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Date Established Residency in this County*

Month

Day

Year

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Phone Number*

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Street Address*

(Veteran's Address)

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City*

(Veteran's Address)

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State*

(Veteran's Address)

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Zip code*

(Veteran's Address)

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How long at address*

(Veteran's Address)

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Name & Address of Landlord / Mortgage Company

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Phone Number*

(Landlord / Mortgage Company)

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Street Address

(Previous Address)

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City*

(Previous Address)

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State*

(Previous Address)

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Zip code*

(Previous Address)

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How long at address*

(Previous Address)

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If Applicant is not the Veteran, please complete the following:

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Is the applicant, the Veteran?*

Yes

No

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Full Name*

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Relation to Veteran*

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SSN

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Date of Birth*

Month

Day

Year

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Address*

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City*

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State*

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Zip code*

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Phone*

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Military Service (Must Have Proof of Service)

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Date From*

Month

Day

Year

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Date To:*

Month

Day

Year

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Type of Discharge*

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Branch of Service*

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Date From

Month

Day

Year

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Date To:

Month

Day

Year

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Type of Discharge

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Branch of Service

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Dependents - Proof of Dependency Required

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Name

(Dependent 01)

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How related:

(Dependent 01)

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SSN

(Dependent 01)

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Date of birth

(Dependent 01)

Month

Day

Year

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In Custody of Whom?

(Dependent 01)

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Support Y / N

(Dependent 01)

Yes

No

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Name

(Dependent 02)

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How related:

(Dependent 02)

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SSN

(Dependent 02)

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Date of birth

(Dependent 02)

Month

Day

Year

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In Custody of Whom?

(Dependent 02)

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Support Y / N

(Dependent 02)

Yes

No

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Name

(Dependent 03)

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How related:

(Dependent 03)

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SSN

(Dependent 03)

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Date of birth

(Dependent 03)

Month

Day

Year

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In Custody of Whom?

(Dependent 03)

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Support Y / N

(Dependent 03)

Yes

No

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Name

(Dependent 04)

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How related:

(Dependent 04)

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SSN

(Dependent 04)

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Date of birth

(Dependent 04)

Month

Day

Year

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In Custody of Whom?

(Dependent 04)

This field is hidden when viewing the form

Support Y / N

(Dependent 04)

Yes

No

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Does anyone else live in your household?*

Yes

No

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Has anyone in your household applied for assistance from any other agency in the last 30 days?*

Yes

No

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Veteran Employment Name

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Veteran Employment Address

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Veteran Employment Start Date

Month

Day

Year

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Veteran Employment End Date

Month

Day

Year

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Veteran Employment Rate of Pay

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Spouse Employment Name

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Spouse Employment Address

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Spouse Employment Start Date

Month

Day

Year

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Spouse Employment End Date

Month

Day

Year

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Spouse Employment Rate of Pay

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Other Employment Name

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Other Employment Address

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Other Employment Start Date

Month

Day

Year

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Other Employment End Date

Month

Day

Year

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Other Employment Rate of Pay

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Are you seeking employment?*

Yes

No

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Have you filed for unemployment benefits?*

Yes

No

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Have you filed for disability benefits?*

Yes

No

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If not seeking employment, explain why*

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Checking Value*

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Savings Value*

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Home Value

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Other Property Value

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Vehicles Value

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Savings / CD

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IRA 401K Value

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Digital Signature*

I understand that false statements made on this application may lead to prosecution. I have completed and /or reviewed all information pertaining to my application for financial assistance And I certify that it is correct to the best of my knowledge.

Δ

VETERANS CRISIS LINE

The Veterans Crisis Line connects Veterans in crisis and their families and friends with qualified, caring Department of Veterans Affairs responders through a confidential toll-free hotline. Veterans and their loved ones can call 1-800-273-8255 and press 1 to receive confidential support 24 hours a day, 7 days a week, 365 days a year. Support for individuals who are deaf or hard of hearing can click here for support. Veterans Crisis Line

Veterans Crisis Line

STAY CONNECTED

Stay connected on all the most recent information, including calendars, news and events that the Veterans Service Commission offers.

REQUEST A SERVICE OFFICER

Have an upcoming event? Request a Service Officer to attend it and serve you.

Cuyahoga County Veterans Service Commission

3950 Chester Ave,
Cleveland, OH 44114

Hours:

Monday-Friday 8:00 a.m. to 3:30 p.m. (Closed From 11:30-12:30 for lunch)

Closed on the Second Friday of each month

*Closed on all federal holidays

Phone:

(216) 698-2600

Toll-Free:

1 (866) 915-8387

Email:

vscmail@cuyahogacounty.gov

VA Crisis Line
Cuyahoga County

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