Service Member Form - Task Force Dagger Special Operations Foundation

TFD Immediate Needs Enrollment Form

Emergency Financial Assistance
Form Title
Requestor Category*

Service Member / Veteran / Family MemberUSSOCOM WCP RFBSNon-Profit Partner / Allied OrgOther
This form is to request financial assistance, if you'd like to speak to a member of our team about Health/Wellness concerns and get enrolled in our Health Initiatives pipeline, please fill out the HI Service Member Enrollment Form located here -

https://form.jotform.com/TFdagger/tfd-HI-enrollment-form
Service Member Info

Please fill out with all of the info possible on the Service Member
Full Name *

First NameLast Name
Date of Birth*

MonthDayYear
Date
Email**
Phone Number*
Please enter a valid phone number.
Special Operations Service Information

TFD is proud to serve the entire SOF community and their families
SOF Military Branch Affiliation*
What is your military affiliation?*
Military Status*
Pay Grade/Rank*
MOS / AFSC / Rate*
Current/Last Unit/Command*
Please upload supporting documentation of special operations connection for our records (DD214, Orders, Awards, SRB/ERB/ORB, Fitreps)

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Please Upload the WCP RFBS Form

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TFD Case Title

How can we help?

Tell us what's going on
What help are you seeking from Task Force Dagger? Be as specific as you can. *
Can you give us the back story on how this situation occurred?*
Was there a triggering event(s) associated with these concerns?*
Example: Divorce, loss of job, death in the family, illness, arrest, etc?
On a scale of 1 to 10, how urgent is your current condition?*
Intake Urgency Category
Total Financial Ask or Estimate*
Is this a reimbursement or is the bill/debt currently outstanding?*

ReimbursementOutstanding bill/debtUpcoming Need
Preferred Method of Payment*

ZelleVenmoCheckPay the bill/debt directly to vendor/creditorOther
Username @ / phone number / email for Zelle/Venmo
Please Upload Any Receipts, Bills, or Supporting Documentation for the Financial Need*

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TFD Immediate Needs Enrollment Form