Justice for Military Families Grant
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Eligibility
Are you a member of the Board of Directors or Pro Bono Committee of the Military Spouse J.D. Network?
*
Yes
No
Servicemember Information:
Servicemember Name
*
First Name
Last Name
Relation of Applicant to Servicemember
*
Please Select
Surviving Spouse
Surviving Child
Surviving Parent
Co-parent with minor child
Military Branch of Servicemember
*
Please Select
Army
Marine Corps
Navy
Air Force
National Guard
Coast Guard
Space Force
NOAA
PHS
Rank of Servicemember
*
Please Select
E-1
E-2
E-3
E-4
E-5
E-6
E-7
E-8
E-9
W-1
W-2
W-3
W-4
W-5
O-1
O-2
O-3
O-4
O-5
O-6
O-7
O-8
O-9
O-10
Date of Loss
*
-
Month
-
Day
Year
Date
Casualty Officer's Name
*
First Name
Last Name
Casualty Officer's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Employer's Name
Employer's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Supervisor's Name
First Name
Last Name
Case Information:
Attorney's Name
First Name
Last Name
Attorney's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Attorney's Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Attorney's Email
example@example.com
Wiring instructions to trust account:
Court in which case is or will be filed:
Case number and name:
Amount requested for court filings:
Proof of ineligibility for court fee waivers (statement that applicant is ineligible for waiver of court filing fees or that no waivers apply for particular fees):
Documentation - Part 1
NOTE: One of the following must be uploaded below to demonstrate financial need.
Copy of most recent tax return:
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Submission of notarized, itemized household budget with proof of monthly income (e.g. bank statements, pay stubs, etc.). If no monthly income exists, a notarized letter from applicant stating such will be accepted.
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Documentation - Part 2
NOTE: One of the following must be uploaded below to show relation to deceased servicemember.
Most recent military dependent ID card:
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Any of the following if available: DD Form 1172 Enrollment Form, DD Form 93 Record of Emergency Data, DD Form 214 Discharge Papers and Separation Documents, DD Form 1300 Report of Casualty, or copy of marriage or birth certificate.
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Letter from Ombudsman:
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Submit
Should be Empty: