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Wisconsin Veterans Homes
Admissions – Eligibility – Forms

Admission Application | Eligibility | Forms


Admission Application

Application forms are available on our website in two formats—Microsoft Word fillable format (you can access, complete, and print from your computer) and Adobe Acrobat PDF format (print from your computer, complete by hand).

Your County Veterans Service Office also can answer eligibility questions and help with the application process.

To arrange for a pre-admission tour call:
  • Veterans Home at Chippewa Falls at (715) 720-6775
  • Veterans Home at King at (715) 258-5586 Ext. 2270
  • Veterans Home at Union Grove at (262) 878-6700 Ext. 6749 or (866) NOW-VETS (866-669-8387)

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Eligibility and Residency Requirements

To be admitted to the Home, veterans must meet criteria for military service and state residency.

The veteran must have entered service from the state of Wisconsin, or must have resided in the state of Wisconsin for 12 consecutive months since his/her discharge from military service. The application form must reflect a Wisconsin address for the home address. A spouse of a veteran can also reside at the Wisconsin Veterans Home, provided they are admitted while the veteran is at some type of facility (i.e. assisted living, nursing home, hospital) or if the spouse is a widow/widower.

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Admissions Forms

Left click an icon below in the Format column to open the file
Right click an icon below to save the file to your computer

= Adobe format

Microsoft Word logo = Fillable Word format

Microsoft Internet Explorer logo = Apply online
Wisconsin Veterans Homes Forms
Form # Form Title / Revision Date Format
WDVA 4000 Application for Admission to the Wisconsin Veterans Home (03/14) WDVA 4000 Application for Admission to Veterans Homes Word fillable formWDVA 4000 in pdf format
WDVA 4002 Authorization for Disclosure of Health Information (02/13) WDVA 4002 Authorization for Disclosure of Health Information pdf formWDVA 4002 Authorization for Disclosure of Health Information Word fillable form
WDVA 4006 Applicant Admissions Checklist – Wisconsin Veterans Homes (08/13) WDVA 4006 pdf formatWDVA 4006 Word fillable format
WDVA 4020A Admission Agreement – Attachment A – Daily Rates (10/14) WDVA 4020A Admission Agreement - Attachment A - Daily Rates pdf formWDVA 4020A Admission Agreement - Attachment A - Daily Rates Word fillable form
WDVA 4020F Admission Agreement – Attachment F – Privacy Practices (08/13) WDVA_4020F-Admission-Agreement-Attachment-F-Privacy-Practices pdf formWDVA_4020F-Admission-Agreement-Attachment-F-Privacy-Practices Word fillable form
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WDVA B0215 Wisconsin Veterans Home at Union Grove Brochure (06/07)
(Assisted Living page revised 03/10; Daily Care Rates page revised 01/12)
WDVA B0215 Wisconsin Veterans Home at Union Grove brochure
WDVA B3401 Wisconsin Veterans Home at King – Caring for America's Heroes (03/14) WDVA B3401 Wisconsin Veterans Home at King brochure
WDVA B3655 Wisconsin Veterans Home at King – Admissions Staff (06/14) WDVA B3655 Wisconsin Veterans Home at King - Admissions Staff brochure
WDVA B3656 Wisconsin Veterans Home at King – What to Bring on the Day of Admission (02/14) WDVA B3656 Wisconsin Veterans Home at King - What to Bring on the Day of Admission brochure
WDVA B6000 Wisconsin Veterans Home at Chippewa Falls (06/13) WDVA B6000 Wisconsin Veterans Home at Chippewa Falls brochure
WDVA P3014 King Walking Tour Map (06/14) WDVA P3014 in PDF format
WDVA P3025 Veterans of King – Letter by Erling Landsverk (10/13) WDVA P3025 in PDF format
WDVA P3027 Wisconsin Veterans Home at King – Medal of Honor Monument Brick Contribution (10/13) WDVA P3027 Medal of Honor Monument Brick Contribution
WDVA P3032 Wisconsin Veterans Home at King – Welcome: What to Expect (02/14) WDVA P3032 Wisconsin Veterans Home at King - Welcome: What to Expect
WDVA P3033 Wisconsin Veterans Home at King – Long Term Care Nursing Resources (02/14) WDVA P3033 Wisconsin Veterans Home at King - Long Term Care Nursing Resources
WDVA P3034 Wisconsin Veterans Home at King – FAQ: Finance (05/14) WDVA P3034 WVH-King FAQ: Finance
WDVA P3499A Wisconsin Veterans Home at King – Information (02/14) WDVA P3034 WVH-King FAQ: Finance
WDVA P3499B Wisconsin Veterans Home at King – Map (02/14) WDVA P3034 WVH-King FAQ: Finance
WDVA P4015 Wisconsin Veterans Homes – Wonderful Places to Live! (10/10) WDVA P4015 WVH Wonderful Places to Live pdf file
WDVA P4020 Did You Know: 70% Rule/Residency (10/13) WDVA P4020 in PDF format
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Wisconsin Veterans Homes

Chippewa Falls
2175 East Park Avenue
Chippewa Falls, WI  54729
Phone: (715) 720-6775
Email: Veterans Home at Chippewa Falls
King
N2665 County Road QQ
King, WI  54946-0600
Phone: (715) 258-5586
Email: Veterans Home at King

Union Grove
21425 G Spring Street
Union Grove, WI  53182
Phone: (262) 878-6700
Toll-free (866) NOW-VETS (866-669-8387)
Email: Veterans Home at Union Grove