Outreach Team direct line: 281-876-6600 (option 3)

Case Manager Supervisor, Jake Hicks (Jake.Hicks.vsd@harriscountytx.gov)

Veterans Coordinator, Lakethia Wilson (lakethia.wilson.vsd@harriscountytx.gov)

Veterans Coordinator, Elizabeth Hernandez (Elizabeth.Hernandez.vsd@harriscountytx.gov)

Outreach Team Intake



Point of Contact First Name:
Point of Contact Last Name:
Relation to Veteran:


Race/Ethnicity:
Hispanic/Latino:
Marital Status:
Currently Serving?:
Branch of Service:
Combat Veteran:
Dates Served From:
Date Served To:
Wartime Period:
Character of Discharge:
Transitioning Veteran?:
Service Related Disability Rating?:

Additional Comments:



Requested Services- Select All That Apply:

Disability Compensation:
Education Benefits:
Employment Assistance:
Financial Management:
Legal:
Caregiver:
Death Pension:
Dependent Indemnity Compensation (DIC):
Vehicle Repair Assistance:
Rent/Utility Assistance:
Request for Military Records:
Transportation:
Housing Assistance (Care Team):
Justice Involved Veteran Assistance (Car:
Rehabilitation Assistance (Care Team):
Other / I Don't Know:



By completing this form, I give permission for my data to be held in a third party database used by Harris County Veterns Services Department (VSD) and agree that the VSD may process personal data relating to me for personnel, administration and/or management purposes as required by law. I give my permission for my contact details to be made available to the VSD described above, and I agree with the statement above.

Data Liability Waiver Signature:

Harris County Veterans Services Department

2929 McKinney St,
Houston, TX 77003

VSOInfo@vso.hctx.net
(281) 876-6600