Apply for Residency

The application for admission (PDF) to a Pennsylvania Veterans Home consists of six parts and requests information needed to determine eligibility for admission.

The application must be completed and submitted in its entirety.

The applicant must complete Parts I, II, III, and IV. Part V consists of the MA51 and Activities for Daily Living Assessment Sheet, both forms must be completed and signed by a physician.

Part VI outreach survey allows us to find better ways to serve all Veterans.  Additionally, a copy of the applicant’s honorable military discharge/separation document must be submitted with the application (DD214 or previous version of the discharge form prior to 1950). If required information is not furnished, the application will be returned for completion resulting in a delay to the admission process. Failure to keep us informed of any address change or telephone contact number could also delay or cancel your admission.

It is the policy of the Department of Military and Veterans Affairs to process all applications without regard to race, color, national origin, religious creed, age, sex, ancestry or handicap.   Any person or organization that provides assistance to the Veteran in preparing the application should do so according to this policy.

In recognition of our position as a health care provider, our six Veterans’ Homes are to be smoke free. Smoking cessation programs are offered by the homes. Please feel free to contact your desired home for more information.

PLEASE NOTE: WE DO NOT ACCEPT FAXED APPLICATIONS. Only the original application with original signatures will be accepted and must be mailed directly to the following address: 

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