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.
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
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
Select the Month, then the year, then the date as well.
Please let us know who referred you to this form.
Adopt-A-Military Family Gift Program
Airman and Family Readiness Center
College Veteran Resource Center
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
Other Non-Profit Organization
Other Business Entity
Previously Assisted Member
Purple Heart Homes
Radio / Media / News
TFAC - Troop and Family Assistance Center
Tri-C Veterans Program
VA - Veterans Administration (Case Worker/Staff)
Veteran Family Services of Family Community Services
VFW - Veteran of Foreign Wars Organization
VSC - Veterans Service Commission
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.
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?
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.
Please annotate the name of the person filling out this form.
Name of Person Requesting Donation
PERSON OR FAMILY IN NEED
First Name of Person in Need
Last Name of Person In Need
Veteran's Street Address
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.
District of Columbia
Air National Guard
Army National Guard
Civilian - Family Member
Civilian / Family Member
Honorably Discharged Veteran
OTH - Other Than Honorable
Post 911 - Medically Discharged Veteran
Retired 20+ years
Retired Active Duty - Honorably 20+ years
Retired Reservist - Honorably 20+ years
Admiral of the fleet
Field Marshal or General of the Army
Marshal of the Air Force
Air Chief Marshal
Lieutenant Junior Grade
Master Chief Petty Officer
Senior Chief Petty Officer
Chief Petty Officer
Petty Officer First Class
Petty Officer Second Class
Petty Officer Third Class
Rate / MOS
Start date of Military Service
How long did you serve?
1 year or less
Total Amount Requesting
Please describe the situation you are in, what caused your financial hardship, and what the funds will be used for.
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?
Payee 1 Amount
Payee 1 Street Address (Where we send the check)
Payee 1 City, State, ZIP
Payee 1 Account Number
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
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.
Send me a copy of my responses
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