Requesting Financial Assistance

When a nonprofit assists an individual, the IRS requires them to keep certain documentation and records on individuals helped. This form helps us meet those requirements.

This is a confidential form and will not be shared with anyone outside of our organization.

Financial Assistance Form

Name of Applicant(Required)

First Last

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Brief description of assistance being asked for: rent, electric, etc.(Required)

Description of why the assistance is needed:(Required)

Amount of assistance needed:(Required)

Upload copy/image of DD214(Required)

Max. file size: 128 MB.

Upload statement showing financial need: to include the amount owed, account number, and contact information

Max. file size: 128 MB.

Signature

Please type your name to sign. By signing this document, you are verifying all information is true and accurate:

The Warrior’s Journey will take all the above information into consideration when determining our ability to help.

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Financial Assistance Form