Application for Admission

The application consists of several parts which must be completed prior to consideration for admission to Nevada State Veterans Home:

  •  Personal Information, such as demographics and Power of Attorney information, as well as information regarding Military Service and Veterans Benefits.
  • Financial information relative to the applicant and spouse.
  • Authorization for use or disclosure of medical information.
  • Physician’s Medical Certificate, which must be completed and signed by physician.
  • VA 10-10EZ is used for enrollment in the VA Healthcare System for nursing home benefits.


You may download and print the application using the link below. Adobe Acrobat Reader is needed to view and print the admission application.  Adobe Reader can be downloaded free of charge at

Mail in the completed application or drop it off in person at the Veterans Home.  The address to mail or hand-deliver completed forms is:

Nevada State Veterans Home
Admissions Department
100 Veterans Memorial Dr.
Boulder City, NV 89005