Emergency Assistance Request

PROJECT: VetRelief provides support for active duty military, our veterans, and their families who reside in the state of Florida

For a check list of required documents, click here.

Please note the following:

Applications will NOT be reviewed until ALL required documents are submitted together Partial applications will not be accepted.
Due to a staff shortage, your application process may take longer than expected.
An interview will be conducted by a local VetRelief Advocate.
Send completed application and ALL supporting documents to applications@projectvetrelief.org.

Fill out the Form below to determine eligibility. Applications will only be processed through applications@projectvetrelief.org
Are you a Veteran or Currently Serving on Active Duty?*
- Yes
- No
Applicant Information
First Name*
Middle Initial
Last Name*
Date of Birth
MM slash DD slash YYYY
Address
Street Address City State ZIP Code
Lived in Florida for how many years?
Telephone*
Email*
Relationship to Veteran or Service Member:*
Please provide brief description of relationship to Veteran or Service Member.
Subject to verification
Veteran Status:*
Deceased Date
MM slash DD slash YYYY
Auxiliary Member?*
- Yes
- No
Unit Number
Sons of the American Legion Member?*
- Yes
- No
Squadron Number
Veteran or Service Member Information
First Name*
Middle Initial
Last Name*
Date of Birth
MM slash DD slash YYYY
Address
Street Address City State ZIP Code
Lived in Florida for how many years?
Telephone*
Email*
Active Duty Dates From
Active Duty Dates To
Type of Discharge
American Legion Member?*
- Yes
- No
American Legion Post Number
Is Veteran or Service Member employed?:
- Yes
- No
Work Status
Please explain work status
Unemployed Status
- Worker's Compensation
- Laid-Off
- Retired
- Other
Please explain work status
What specific steps have been taken to secure employment?:
Applicant's Spouse Information
First Name
Middle Initial
Last Name
Date of Birth
MM slash DD slash YYYY
- Same Address as Above
Address
Street Address City State ZIP Code
Lived in Florida for how many years?
Telephone
Email
Is Spouse employed?
- Yes
- No
Work Status
Please explain work status
Unemployed Status
- Worker's Compensation
- Laid-Off
- Retired
- Other
Please explain work status
What specific steps have been taken to secure employment?:
Family Information
Does Applicant have any children under the age of 17
- Yes
- No
Does the child or children reside in the home full-time?
- Yes
- No
Please Explain
Who has legal custody of the child or children?
Do both parents live in the home?
- Yes
- No
If no, which parent is absent?
- Mother
- Father
Reason
Please explain
Children Information
Child's Name
First Last
Age
School Grade
Child's Name
First Last
Age
School Grade
Child's Name
First Last
Age
School Grade
Child's Name
First Last
Age
School Grade
*Please add additional children information in comments below, if necessary.
Financial Information
Have you applied for other financial support?
- Yes
- No
Brief Summary of Additional Funding Information (check all that apply)
- American Legion Post, Auxiliary Unit, or SAL Squadron
- Assistance for Needy Families
- VA Disability Pension
- Social Security Disability
- Supplemental Security Income
- Medicaid
- Food Stamps
- Women, Infants, & Children (WIC)
- Public Assistance
- Private Charities
- Other
Additional information for American Legion Post, Auxiliary Unit, or SAL Squadron:
American Legion Post, Auxiliary Unit, or SAL Squadron #
Date Applied
MM slash DD slash YYYY
Status
- Approved
- Denied
- Pending
Amount, if approved OR explanation, if ineligible.
Additional information for Assistance for Needy Families:
Date Applied
MM slash DD slash YYYY
Status
- Approved
- Denied
- Pending
Amount, if approved OR explanation, if ineligible.
Additional information for VA Disability Pension:
Date Applied
MM slash DD slash YYYY
Status
- Approved
- Denied
- Pending
Amount, if approved OR explanation, if ineligible.
Social Security Disability
Date Applied
MM slash DD slash YYYY
Status
- Approved
- Denied
- Pending
Amount, if approved OR explanation, if ineligible.
Supplemental Security Income
Date Applied
MM slash DD slash YYYY
Status
- Approved
- Denied
- Pending
Amount, if approved OR explanation, if ineligible.
Additional information for Medicaid:
Date Applied
MM slash DD slash YYYY
Status
- Approved
- Denied
- Pending
Amount, if approved OR explanation, if ineligible.
Additional information for Food Stamps:
Date Applied
MM slash DD slash YYYY
Status
- Approved
- Denied
- Pending
Amount, if approved OR explanation, if ineligible.
Additional information for Women, Infants, & Children (WIC):
Date Applied
MM slash DD slash YYYY
Status
- Approved
- Denied
- Pending
Amount, if approved OR explanation, if ineligible.
Additional information for Public Assistance:
Date Applied
MM slash DD slash YYYY
Status
- Approved
- Denied
- Pending
Amount, if approved OR explanation, if ineligible.
Additional information for Private Charities:
Date Applied
MM slash DD slash YYYY
Status
- Approved
- Denied
- Pending
Amount, if approved OR explanation, if ineligible.
Additional information for Other Assistance:
Organization Name
Date Applied
MM slash DD slash YYYY
Status
- Approved
- Denied
- Pending
Amount, if approved OR explanation, if ineligible.
Please provide brief description about additional funding source:
Monthly Income and Expenses
Please provide Household Monthly Income and Expenses.

*ONLY include recurring monthly income & expenses. DON'T include one-time assistance or accumulative balances!
MONTHLY INCOME
Earnings of Veteran
Earnings of Spouse/Parent
Earnings of others in household
VA Pension(s)
Public Assistance
Other Monthly Income
Specify
TOTAL INCOME
Price: $0.00
MONTHLY EXPENSES
Shelter
Electricity
Gas
Water/Sewage
Waste
Food
Clothing
TOTAL EXPENSES
Price: $0.00
HARDSHIP DETAILS
Please explain your recent viable hardship.*
Briefly explain your current situation and why you are needing financial support.
REQUEST DETAILS
What are you requesting assistance for?*
Please select what type of assistance you are needing help with.
Please explain.
What expense are you requesting assistance for?
Total Amount:*

What is the total amount you are requesting from PROJECT: VetRelief?
Referral Information
How did you hear about us?
American Legion Post #:
Auxiliary Unit #:
Sons of the American Legion Squadron #:
Legion Riders Chapter #:
Which County:
VA Medical Center Location:
Which Veteran Service Organization?
Website:
Tell us how your heard about us:
- Check here if you are a VetRelief Advocate filling out this form for someone else
What Post, Unit, Squadron, or Riders #:
Name
First Last
Additional Documents
The following documents may be requested upon receipt of application. The PROJECT: VetRelief Veteran Services Director will contact you to complete the application process:
- DD214
- Marriage License, if applicable
- Birth Certificate (for minor children only)
- Other Supporting Documents *
*Other supporting documents can include, but not limited to: bank statements, bills, lease agreement, foreclosure documents, eviction notice, disconnection notices, custody documents, adoption papers, legal name change documents.
Additional Comments

PROJECT: VetRelief provides support for active duty military, our veterans, and their families who reside in the state of Florida

Applicant Information

Veteran or Service Member Information

Applicant's Spouse Information

Family Information

Children Information

Financial Information

Additional information for American Legion Post, Auxiliary Unit, or SAL Squadron:

Additional information for Assistance for Needy Families:

Additional information for VA Disability Pension:

Social Security Disability

Supplemental Security Income

Additional information for Medicaid:

Additional information for Food Stamps:

Additional information for Women, Infants, & Children (WIC):

Additional information for Public Assistance:

Additional information for Private Charities:

Additional information for Other Assistance:

Monthly Income and Expenses

MONTHLY INCOME

MONTHLY EXPENSES

HARDSHIP DETAILS

REQUEST DETAILS

Referral Information

Additional Documents

The following documents may be requested upon receipt of application. The PROJECT: VetRelief Veteran Services Director will contact you to complete the application process:

Emergency Assistance

GET ASSISTANCE

Benefits Support

GET SUPPORT

Community Engagement

GET ENGAGED