Assistance Request

Please read this form carefully, fill out completely and email with your request.

Requesting assistance for the following veteran:

Veteran's Address
4 characters left

Last 4 digits of Veteran's SSN

Veteran Spouse Information *

Veteran in question has a spouse or significant other that is the primary account holder on any bills.

Name of Veteran's Spouse or Significant Other

Required Documentation

Applicant must include reason for Less Than Honorable Discharge or Dishonorable Discharge and supporting documentation to be considered for assistance.

Letter from the referring Agent/Case Manager, on agency letterhead that includes the reason(s) the veteran needs help. The letter must contain the veteran’s name, address, and phone number.

Letter from Veteran outlining circumstances and request for assistance to include explanation of financial hardship.

If requesting rent assistance: Landlord information – include name, address, phone number – be certain the “Payable To” information is correct. First and last page of the lease, or eviction notice is required.

If requesting utility payment assistance: The actual invoice (computer printouts will not be accepted).

List of all organizations that have been contacted, if they have helped or not, and how much.

FW22 reserves the right to request additional supporting documents.

  • Credit cards, military charge cards, retails cards
  • Personal, student or payday loans
  • Cable, internet or secondary phones
  • Cosmetic or investigational medical procedure expenses
  • Taxes - property or otherwise
  • College expenses
  • Furniture rentals
  • Other expenses not determined to be a basic life need

The eligible and ineligible expense lists are not all inclusive and each expense will be considered on a case-by-case basis. Payment will be made at the discretion of the approving committee. Payments are made directly to creditors/utility company/landlords etc.

Complete applications and supporting documents will be submitted here. Any additional information can be emailed to

Volunteer Signup


All information is optional:

(Veteran, Spouse, Child, Etc.)