Financial Assistance Request
Qualifying Requests - Please note:
Emergency financial assistance requests are intended to support active or reserve military service members, honorably discharged veterans and/or their immediate household families.
We work with many community partners who we consider to be sources of solutions. Your request may also be connected to one of our community partners to best serve your needs.
Typical requests range between $100-$500 with a maximum of $500 per person per year. Amounts more than this will be considered on a case by case basis, but are more likely to be declined. Our goal is to help as many as we can. By limiting the per person funds, allows us to help more service members or veterans.
VERY IMPORTANT:
Please attach proof of service such as a DD214, recent LES, or copy of ID. Requests without supporting documentation will be declined.
Also attach a copy of your "BILL or INVOICE" that you are requesting NEOPAT to fund. NEOPAT will only fund directly to the 3rd party bill or invoice. We do not provide funding directly to the service member or veteran. Without an attached document, your request will be declined. It is important that the invoice or bill match the PAYEE info included below. The bill should show the Service Member or Veteran's name. DO NOT submit requests until you are prepared to upload the appropriate documentation. Requests lacking the documentation will be declined and will require re-submission.
Normal requests are processed in approximately 2 weeks with checks being made payable and mailed directly to the invoice, lease or utility bill. You will receive an E-mail with a survey once your request has been paid or declined. Please express any gratitude in that survey as it is used to show appreciation to our donors who support financial assistance requests.
We appreciate your service and look forward to assisting you!
Statement of Understanding
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I affirm that the "Person in Need" is a United States active or reserve military service member, or honorablly discharged or retired veteran or of their immediate household family.
I acknowledge that I may be contacted by a third party non-profit organization or a government agency in order to best serve my request.
Affirm with Checkmark:
Date of Request
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Select the Month, then the year, then the date as well.
Referred by:
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Please let us know who referred you to this form.
Adopt-A-Military Family Gift Program
Airman and Family Readiness Center
American Legion
College Veteran Resource Center
Community Event
Facebook / Twitter / Social
Friend or Family Member
Military Command / Unit Leadership
Modern Warrior Live
NEOPAT - Board Member / Executive Director / Web
NEOPAT - Volunteer
Northeast Ohio Veteran Community Task Force
Ombudsman
Other Non-Profit Organization
Other Business Entity
Previously Assisted Member
Purple Heart Homes
Radio / Media / News
Red Cross
SAM Center
TFAC - Troop and Family Assistance Center
Tri-C Veterans Program
VA - Veterans Administration (Case Worker/Staff)
Valor Home
Veteran Family Services of Family Community Services
VFW - Veteran of Foreign Wars Organization
VSC - Veterans Service Commission
-Not Listed-
Resource Result
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If you are a Veteran - Have you spoken yet to the Veteran Service Commission for your particular county about this request?
If you are active duty or a drilling reservist, have you spoken to the Troop and Family Assistance Center yet?
All active duty or drilling reservists should first speak to the Troop and Family Assistance Center. All DD214 Veterans should consult with their County Veteran Service Commission first.
NEOPAT accommodates unique requests or unsupported situations after those two agencies.
Please select:
Yes, I've spoken to the VSC but was disapproved.
Yes, I've spoken to the VSC and was approved.
Yes, I've spoken to TFAC - but not eligible.
Yes, I've spoken to TFAC - they are helping me.
No, NEOPAT is my first step for support.
Have you asked for support through other agencies?
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What other agencies have you already contacted for support and what were the reasons for denial. If NEOPAT is your first attempt for support - please note N/A.
REQUESTER
Please annotate the name of the person filling out this form.
Name of Person Requesting Donation
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Requester Phone
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Requester Email
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PERSON OR FAMILY IN NEED
First Name of Person in Need
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Last Name of Person In Need
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E-mail Address
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Cell Phone
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Veteran's Street Address
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City
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County
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The primary residence of the person or family in need must be in the 20-county Northeast Ohio service area. Those counties are: Ashland, Ashtabula, Columbiana, Cuyahoga, Erie, Geauga, Holmes, Huron, Lake, Lorain, Trumbull, Mahoning, Medina, Ottowa, Portage, Richland, Sandusky, Stark, Summit, and Wayne.
Ashland
Ashtabula
Columbiana
Cuyahoga
Erie
Geauga
Holmes
Huron
Lake
Lorain
Trumbull
Mahoning
Medina
Ottowa
Portage
Richland
Sandusky
Stark
Summit
Wayne
Other
State
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
OCONUS
Zip
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MILITARY SERVICE
Military Branch
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Air Force
Air National Guard
Army
Army National Guard
Coast Guard
Marine Corps
Navy
Civilian - Family Member
Military Status
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Active Duty
Civilian / Family Member
Drilling Reservist
Family Member
Honorably Discharged Veteran
Medically Discharged
OTH - Other Than Honorable
Post 911 - Medically Discharged Veteran
Reserve
Retired 20+ years
Retired Active Duty - Honorably 20+ years
Retired Reservist - Honorably 20+ years
Military Title
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Civilian
Admiral of the fleet
Field Marshal or General of the Army
Marshal of the Air Force
Admiral
General
Air Chief Marshal
Vice admiral
Lieutenant General
Air Marshal
Rear Admiral
Major General
Air Vice-Marshal
Commodore
Brigadier
Brigadier General
Air Commodore
Captain
Colonel
Group Captain
Commander
Lieutenant Colonel
Wing commander
Lieutenant Commander
Major
Commandant
Squadron Leader
Captain
Flight Lieutenant
Sub-Lieutenant
Lieutenant
Lieutenant Junior Grade
First Lieutenant
Flying Officer
Ensign
Second Lieutenant
Pilot Officer
Midshipman
Officer Cadet
Warrant Officer
MCPON
Master Chief Petty Officer
Senior Chief Petty Officer
Chief Petty Officer
Sergeant Major
Petty Officer First Class
Petty Officer Second Class
Petty Officer Third Class
Sergeant
Corporal
Bombardier
Seaman
Airman
Fireman
Construction-man
Private
Gunner
Trooper
Pay Grade
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E-1
E-2
E-3
E-4
E-5
E-6
E-7
E-8
E-9
O-1
O-2
O-3
O-4
O-5
O-6
O-7
O-8
O-9
O-10
Rate / MOS
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Military Command
Unit
Start date of Military Service
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How long did you serve?
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Bootcamp Only
1 year or less
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
11 years
12 years
13 years
14 years
15 years
16 years
17 years
18 years
19 years
20 years
21 years
22 years
23 years
24 years
25 years
26 years
27 years
28 years
29 years
30 years
30+ years
REQUESTED AMOUNT
Total Amount Requesting
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Please describe the situation you are in, what caused your financial hardship, and what the funds will be used for.
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PAYEE(s) (if known) - > Incomplete will cause delay. <
NEOPAT cannot issue a check or cash directly to the individual in need. Rather, the payee must be identified as a separate entity related to either an attached invoice or bill and MUST be included with this request.
In the next section, please include the full name, mailing address, and account number (if applicable) of one or more payees. (Maximum of 2)
If this request is for an unidentified amount or an unidentified payee, such as a home repair or car repair, it is still best to obtain a documented amount first, and then submit with your request.
No request can be approved without us first knowing who we are to pay, how much the request is for and where to send the check.
REQUIRED: The exact supporting documentation such as a utility bill, car loan payment coupon, or a rental lease agreement, matching the Payee Info is required for our treasurer to fund.
We review requests daily, however, we approve them weekly. Please allow 10 days to 2 weeks for check to be mailed to the payee. We will notify you via E-mail if/when your request is approved or declined and a check has been sent.
We genuinely appreciate your service and are more than willing to assist.
PAYEE 1 - Who do we make the check payable to?
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Payee 1 Amount
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Payee 1 Street Address (Where we send the check)
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Payee 1 City, State, ZIP
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Payee 1 Account Number
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Please make sure this number is accurate or N/A
PAYEE 2 Who do we make a 2nd check payable to? (If applicable)
Payee 2 Amount
Payee 2 Street Address (Where we send the check)
Payee 2 City, State, ZIP
Payee 2 Account Number
Please make sure this number is accurate!
Date Needed By
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ATTACHMENTS
PREVENT DELAY - Please attach your specific bill to be paid and your proof of service here. With out proof of service and an attached bill or invoice, your request will be declined. DO NOT submit requests with out supporting documentation.
Attachments
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Email address
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