Accommodation Assistance Application Form
To qualify, the veteran must reside in Michigan and the need for accommodation must be service related .Once your application is received, it will be reviewed to determine if the necessary requirements are met. You will receive a response within 3 days.
Nomination of Veteran
If nominating a Veteran, are they to be contacted?
Veteran's Date of Birth
The address below is for:
Street Address Line 2
State / Province
Postal / Zip Code
Phone Number Provided is for:
Email Provided is for:
Branch of Service
Has the Veteran received assistance for other Non Profit Organizations in the past 12 months?
If so, what organization and what was the circumstance?
Does the Veteran have a VA Disability Rating?
If so, at what rating?
Were the injuries sustained in Combat?
Please describe, in detail, the assistance needed
Please submit any supporting documentation (DD214, VA Disability Letter, any other documentation to assist with our decision)
Should be Empty:
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