American Military Family Veterans & First Responders Assistance
The majority of funds for this program are provided by the Colorado Supports the Troops License Plate Program. These funds are RESTRICTED to Colorado Residents only. Note: All other applicants - Please be advised that you may be referred to other nonprofits located within your state of residence.LES / DD214 / Additional Pay Stubs. ************************************** (Printed Form MUST be Emailed to moreinfo@amf100.org or Fax to 720-408-9936 with documents)
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Service Member's Full Name
*
First Name
Last Name
Rank
*
Branch of Service
*
Airforce
Army
Coast Guard
Marines
Navy
Years of Service
*
Deployment Status:
*
Yes
No
Deployment Dates
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Colorado Resident
*
Yes
Stationed in Colorado
Other
Phone Number
*
-
Area Code
Phone Number
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Please Provide the following information
Limited funding:Program qualifications for emergency financial assistance are restricted to OIF/OEF suffering from PTSD and/or TBI active or veteran US military service members.One time request per household will be considered. Multiple request will not be considered.
Applicants Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
E-mail
*
Relationship to Service Member
*
Number of Children
*
Name/s & Age/s of Dependents
*
$$ Amount Requested
*
Explain in your own words why you are in need of assistance, be specific.
*
Applicant's Certification
Read each statement carefully
Certification
*
The disclosure of this information on my application is voluntary.
Certification
*
All information requested will be used only for determining eligibility for assistance.
Certification
*
The failure to provide all requested information will result in disapproval of this application
Certification
*
AMF may investigate my credit history and/or bank account information as related to determination for grant elgibility.
Signature
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Monthly Income
Enter 0 if not applicable. Enter amounts in whole dollars.
Base Pay
*
BAH
*
Family Separation Allowance
*
BAS
*
Sea Pay
*
Imminent Danger Pay
*
Hazadous Duty Pay
*
COLA
*
Child Support Received
Second Income
Other
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Monthly Expenses
Enter 0 if not applicable. Enter amounts in whole dollars.
Federal/State Taxes/SSN
*
Alimony/Child Family Support
*
Deployed Member Expense
*
Rent/Mortgage
*
Utilities
*
Telephone Expense
*
Food & Household Supplies
*
Clothing
*
Vehicle Expense
*
House Personal Property Insurance
*
Child Care
*
Creditor Payments 1
*
Creditor Payment 2
*
Medical /Dental
*
Explanation of Expense:
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Your application is not completed and will not be reviewed until the following documents are received:
LES / DD214 / Additional Pay Stubs (If you wish to Print Form please email documents & form to moreinfo@amf100.org or Fax to (720-408-9936)
Upload Documents
*
DD214: LES: VA Documentation: Bill
pdf, doc, html, zip, mp3, avi, jpg, png etc.
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