Survivors Application For Financial Assistance - Children Of Fallen Soldiers Relief Fund
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1CHILDREN OF FALLEN SOLDIERS RELIEF FUND
The Children of Fallen Soldiers Relief Fund Was Founded To Honor Our Service Men and Women Who Have Lost Their Lives For
Our Continued Freedom by Providing Surviving or Severely Injured Veteran’s with dependent children financial assistance during
their time of hardship. Please include a copy of your most recent tax filing even if you have not filed for several years, all military
dependent ID cards and/or copies of DD 1172 enrollment form, DD 93, DD 214, DD1300. A one-page statement concerning your
reason for requesting funds, the amount requested, the specific purpose to which the funds will be applied, a breakdown of monthly
income and expenses, two recent months of bank statements and current bills that are in arrears. Incomplete applications will not be
considered. It is the applicant’s responsibility to complete all required documentation in order to be considered for assistance. Note:
additional documents may be requested in order to complete the application process.
SURVIVORS APPLICATION FOR FINANCIAL ASSISTANCE
APPLICANT NAME:_____________________________________________________________
_________________________
ADDRESS: ________________________________________
CITY:________________________________________________STATE:______ZIP:_______________
DAY PHONE:________________________EVE PHONE:_____________________________________
SSN:_______________DOB:_________EMAIL:______________________
APPLICANT’S HIGHEST LEVEL OF EDUCATION: _________________
NAME OF DECEASED SPOUSE/PARENT :_______________________________________________
MILITARY BRANCH: ________________DATE OF LOSS:___________
RANK:_________CASUALTY OFFICER'S NAME:__________________________________________
CASUALTY OFFICER'S PHONE NO._____________________________________________________
EMPLOYERS NAME:__________________________________________________________________
ADDRESS:__________________________________________________________________________
_
SUPERVISORS NAME :_________________________ PHONE:________________________________
OTHER CHILDREN WHO QUALIFY AS A DEPENDENT OF THE ABOVE DECEASED WHO ARE
CURRENTLY UNDER YOUR LEGAL CUSTODY:
NAME:____________________________________DOB:______________
NAME:____________________________________DOB:______________
NAME:____________________________________DOB:______________
NAME:____________________________________DOB:______________
PLEASE PROVIDE CONTACT INFORMATION FOR OTHER FAMILY MEMBERS OF DECEASED:
NAME:___________________________________________________PHONE:____________________
ADDRESS:__________________________________________________________________________
EMAIL:________________________RELATIONSHIP:_______________
___________________________NAME:________________________PHONE:____________________
ADDRESS:__________________________________________________________________________
EMAIL:________________________RELATIONSHIP:_______________
TOTAL MONTHLY INCOME:___________TOTAL MONTHLY EXPENSES:___________________
DATE OF
APPLICATION:_______________________SIGNATURE:_____________________________________
HOW DID YOU HEAR ABOUT
US?________________________________________________________
Please remember to attach a copy of your most recent tax return with this application. Grant recipients will
be selected in accordance with criteria established by Children of Fallen Soldiers Relief Fund and are
based on need and the amount of proceeds available for disbursement at the time of application.
Proceeds will be disbursed only upon clarification of information received. Grant recipients hereby
authorize CFSRF, its Directors, Board Members, trustees, employees, agents, licensees, successors and
assigns to take pictures and interview family members and grantees for the sole purpose of furthering the
charitable purpose of CFSRF. Visit our website at:
Mail, fax or email the completed form and all attachments to:
CFSRF, P.O. Box 1099, Temple Hills, MD 20757
Telephone (301) 685-3421 or (866) 96-CFSRF Fax (301) 685-3271 or (301) 630-0592
Email:
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