Chester County District Attorney's Office

dacontact@chesco.org

201 W. Market St., Suite 4450
West Chester, PA 19382

610-344-6801

Veteran's Court Application

Phone

Alternate Phone

Is the client currently incarcerated at Chester County Prison?

Date of incarceration

OTN(s)

Case Number(s)

Current Criminal Charges

Is the client currently on probation/parole?

How long did you serve in the Armed Forces?

What type of discharge did you receive?

Have you ever served in any capacity in combat?

Where were you stationed during combat / theater?

Have you ever been stationed or deployed outside of the US?

Where were you deployed?

Have you ever been awarded an overseas deployment badge or ribbon?

Where were you awarded a badge or ribbon?

MOS Number

Have you ever received services at a VA hospital?

At what hospital did you receive services?

Referrer Name

Referrer Email

ReferingAgency (if applicable)

Relationship to client

Attorney Name

Attorney Email

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