• This program is supported by a grant from the Texas Veterans Commission Fund for Veterans’ Assistance. The Fund for Veterans’ Assistance provides grants to organizations serving veterans and their families. For more information, visit www.tvc.texas.gov.

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  • General Assistance Program Participant Application

  • Applicant intake form based on scanned source document
  • ORGANIZATION                                  The Warriors Refuge
  • INSTRUCTIONS                                 Please complete all required fields marked with an asterisk (*).
  • Applicant Information

  • * Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • We currently provide services only in select counties. Please select which County you reside in.*
  • Format: (000) 000-0000.
  • Emergency Contact

  • Format: (000) 000-0000.
  • May we contact this person in an emergency?
  • Participant Demographic Information

  • * Race*
  • * Ethnicity*
  • * Gender*
  • * Marital Status*
  • Veteran Information

  • * Veteran Status*
  • Veteran Status Verification Method
  • * Does veteran have a DD214 at time of intake?*
  • * Branch of Service*
  • Service and Discharge Information

  • * Entry Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • * Discharge Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • * Discharge Status*
  • Combat Service?
  • Location of Combat Service
  • Dependent Information

  • Dependent Relation to Veteran
  • Does the client reside with the veteran and has the address been verified?
  • Household Information

  • Gross Household Income
  • Applicant Certification

  • Notice of Services
    Financial Assistance Program funded through the Texas Veterans Commission General Assistance Grant
     
     
    Participant Notice
     
    The Warrior’s Refuge provides limited emergency financial assistance to eligible Veterans, Dependents, and Surviving Spouses through the Texas Veterans Commission General Assistance Grant in Brazoria, Fort Bend, Galveston, Harris, Jefferson, and Matagorda Counties. Assistance is intended to help stabilize households experiencing financial hardship and to prevent a short-term crisis from becoming a housing, utility, or transportation emergency.
    Services are not guaranteed and are provided only after eligibility is verified, documentation is complete, the requested expense is allowable under the grant, and grant funds are available.
     
    Who May Apply
     
    Eligible participants may include Veterans, Dependents, and Surviving Spouses who meet Texas Veterans Commission beneficiary eligibility requirements and the specific requirements of this financial assistance grant. Before services are provided, participants must complete intake and provide required documentation verifying identity, Texas residency, military service or qualifying relationship to the Veteran, and financial need.
    For General Assistance – Financial Assistance, participants must demonstrate financial need through an explanation of hardship and a signed attestation. Additional documentation may be requested to confirm eligibility, household circumstances, vendor information, account balances, arrears, or the requested expense.
     
    Covered Services
     
    Service Category
    Examples of Covered Assistance
     
    Mortgage Assistance
    Mortgage payments, escrow, and payments in arrears.
     
    Rent Assistance
    Rent payments, application fees, deposits, late fees, and rent payments in arrears.
     
    Utility Assistance
    Electric, water, gas, garbage, internet, and the household primary user’s cell phone service, including connection or reconnection fees, late fees, and payments in arrears.
     
    Transportation – Primary Vehicle
    Fuel, necessary repairs, insurance, vehicle loan payments, and late fees when tied to basic needs, work, school, or medical appointments.
     
    Transportation – Rides
    Third-party transportation such as daily, weekly, or monthly bus, train, or metro rail passes, ride-share, or cab fare in the local area.
     
     
     
    Program Limits and Availability
     
    · Each eligible participant may receive financial assistance up to two times per year.
    · Assistance is available only as grant funds allow.
    · Assistance is paid according to program procedures and may require coordination with landlords, mortgage companies, utility providers, transportation vendors, repair providers, or other approved vendors.
    · Grant funds will not cover taxes on any items, purchases, services, invoices, fees, or vendor charges. Participants are responsible for any tax amount owed unless another non-grant funding source is approved.
     
    Submitting an application does not guarantee approval or payment.
     
    Participants must provide complete and accurate information. Missing or incomplete documentation may delay or prevent assistance.
     
    How to Request Assistance
    · Participants may request services by contacting The Warrior’s Refuge at 979-345-3800, applying online through the organization’s website contact page, or requesting services by walk-in. Services are provided by appointment, and participants must meet with an employee or case manager to complete intake, eligibility screening, documentation review, and service planning.
    · Once eligibility is determined and all required documentation is received, The Warrior’s Refuge will work to provide approved services as quickly as possible, generally within five business days.
     
    Participant Acknowledgment
     
    By applying for assistance, the participant acknowledges that services are limited, eligibility must be verified, taxes are not covered by grant funds, assistance may be provided no more than two times per year, and all services are subject to the availability of Texas Veterans Commission General Assistance Grant funds.


    Signature Acknowledgment
    By signing below, I acknowledge that I have received and reviewed this Notice of Services, understand the eligibility requirements and service limitations, and understand that assistance is subject to approval and availability of Texas Veterans Commission General Assistance Grant funds.


     

  • I certify that the information provided on this application is true and complete to the best of my knowledge. I understand that providing false or incomplete information may affect eligibility for assistance.
  • Date
     - -
    2 digit month, 2 digit day, 4 digit year
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