Passenger Travel Request

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Pilots
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Veteran & Advocates
Ground Control

Instructions

The first step to a VAC flight is submitting this travel request form. While not all fields are required, any additional information you can provide will speed up the process.

Please Note: not all fields may apply to you. If you represent an agency, organization or healthcare facility that is making the request on behalf of the veteran, please provide the appropriate information. Family members and friends need not complete the Agency or Health Care facility fields.

Beneficiary Information Veteran's First Name*
Veteran's Last Name*
Veteran's Branch of Service
Veteran's Rank
Health Care Facility Name

Trip Requestor Contact Information First Name*
Last Name*
Home Phone Number Preferred Contact Method Preferred
Work Phone Number Preferred Contact Method Preferred
Mobile Phone Number Preferred Contact Method Preferred
*At least one phone number is required.

Email Address*
Relationship Family/Friend
Agency/Organization
Agency/Organization

Travel Needs Number of Passengers*
Trip Type One Way
Round Trip
Origin City & State Origin State
Destination City & State Destination State
Departure Date

Clear
Departure Date Flexibility

Return Date

Clear
Return Date Flexibility

Ground Transportation Needed At Origin
At destination
Reason for trip. * Please enter a brief explaination below noting the reason for the travel request. (And any additional information which would be helpful.)

VAC Passenger Acknowledgement* I accept

View Passenger Acknowledgement

* Required Field