Application for Admission

From this page, you can begin the process of applying for admission to the Nevada State Veterans Home (NSVH).  There are two types of application processes – one for those who are residing at home or in a residential setting, and one for those who are residing in a healthcare facility.  Be sure to select the appropriate application below. 

Since you will not be able to save the forms after you begin completing them, it is recommended you gather all information needed in advance.  Additionally, please print and make a copy of the forms for your files prior to submitting them.  All forms are available to print below. 

For those who are residing at home or in a residential setting, this application consists of several parts which must be completed prior to consideration for admission to NSVH:

  • Section I addresses Personal Information, such as demographics and Power of Attorney information, as well as information regarding Military Service and Veterans Benefits.
  • Section II addresses financial information relative to the applicant and spouse.
  • Section III addresses authorization for use or disclosure of medical information.
  • Section IV is the Physician’s Medical Certificate.
  • VA 10-10EZ is used for enrollment in the VA Healthcare System for nursing home benefits.

Sections I and II may be submitted online by clicking here, or printed and submitted to the address below.  Section III must be printed and signed by the applicant or responsible party.  Section IV must be printed, completed and signed by a physician.  A VA 10-10EZ must be printed and signed by the applicant or responsible party.  All five forms should be returned to the Nevada State Veterans Home at the address below.

For those who are residing in another healthcare facility, this application consists of two parts which must be completed prior to consideration for admission to NSVH:

  • The Facility Application Form requests the applicant’s information, as well as a listing of documents required for review.  This form, along with required documentation, is required prior to consideration for admission.
  • The VA 10-10EZ is a form used for enrollment in the VA Healthcare System for nursing home benefits, which should be filled out by the applicant or their responsible party.   

The Facility Application Form may be submitted online by clicking here, or printed and submitted to the address below.  The VA 10-10EZ must be printed, signed by the applicant or their responsible party, and returned to the Nevada State Veterans Home at the address below.

Forms
We are providing you with the application forms you will need in the following linkes. Click on each one of the links and complete and print the form. You need Adobe Acrobat Reader to view or complete the admissions application.  Adobe Reader can be downloaded free of charge at www.adobe.com

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

 

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