Adopt A Hero Program for Veterans In Financial Need - Application Form

ADOPT A HERO PROGRAM FOR VETERANS IN FINANCIAL NEED.

Assistance is available to veterans and their families that are in NEED

Please keep your gift requests at $100 per child. ALL electronics including cell phones are not considered a NEED. Upon receiving gifts, we ask that you kindly write a letter of gratitude or simply fill out a card for your sponsor to show that you have indeed received your items.

Your application will be matched with one of our sponsors who will use your list as a guide when purchasing items. Please be as specific as possible when filling out the application. Your personal information will not be shared with the sponsor unless you specifically tell us to.

Please have your DD214 Member4 copy, Children’s Birth Certificates, and Marriage Certificate if applicable, military ID or VA card, driver's license, THREE months of bank statements, VA award letter, copy of SSD or SSI award letter, proof of spouse or significant others income, proof of credit card statements, proof of car payments or insurance if available, and proof of rent/ mortgage prior to completing as you must upload them to this application prior to hitting the Submit Button. We will contact you if we have any questions or if you are not approved.

UPLOAD DOCUMENTS (SEE ABOVE)(Required)

Drop files here or

Max. file size: 5 MB, Max. files: 15.

What COUNTY do you live in?(Required)

Phone(Required)

Email(Required)

How did you hear about this program?(Required)

Military Status(Required)

Branch of Service?(Required)

How many immediate family members? (including veterans)*(Required)

First Name Only, gender, age (veteran/service member)(Required)

Veteran's Wish List(Required)

Spouse/Significant other FIRST Name only, gender, age

Spouse/Significant other Wish List

Child Name(s), age(s), and gender(s), wish list (separated per child)

Household Goods/Cleaning Supplies/Personal Items(Required)

List items for the household, such as small kitchen items, cleaning supplies and personal hygiene items.

Please provide a brief summary as to why you are in need of assistance and how the situation occurred. This is NOT meant to be a way of humiliation, it is meant for us to have a better understanding of how your situation came about and potentially may have programs to further assist you*(Required)

Please list all who referred you to WNYHeroes. We need the contact name/number (i.e. caseworker), the organization name (i.e. VA Hospital, American Legion, AMVETS, VVA, VOC, VOS)(Required)

Please list any organizations in which you have applied for assistance in the last three (3) years. Include the amount given and the date or if you have an application pending

INCOME: Please list ALL sources of FAMILY income, including, but not limited to: any salary, social security, VA benefits, support from other organizations, investment income etc. for ALL household members residing at the same address

Place of employment(Required)

List all income PER MONTH(Required)

Total income(Required)

Please include ALL Family living expenses (i.e. rent/mortgage, utilities, insurance, food, transportation, medical, credit cards and other living expenses whether or not you are requesting assistance for that specific expense). For each expense, please indicate if the expense is a recurring expense or a one-time expense. Please explain any unusual or exceptionally large expenses.(Required)

Total monthly expenses(Required)

We reserve the right to place calls to the following (Landlord, Bank, Utility, social worker, caseworker, or other) to confirm your request/need for our assistance.

Signature

Adopt A Hero Program for Veterans In Financial Need – Application Form

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