Veterans Application for Assistance

Veteran Application for Assistance

Please fill out the below information if seeking assistance.  One of our Warrior Board members will be contacting you shortly.

Keep in mind, be as specific and detailed as possible.

We have helped not only using our own programs, but programs across the United States.  The more we know, the better we can get you connected to the right resources.

**Disclaimer:  Our Heroes’ Dreams does not share this information with 3rd parties or those outside of Our Heroes’ Dreams. The information obtained is only used to get you the help you need.  Our Heroes Dreams fully understands the need for confidentiality in these matters.

First Name

Last Name

Middle Initial

Gender
malefemale

DOB

Marital Status

Children

Names and Ages of Family Members - Please List

Current Occupation

Street Address

City

State

Zip Code

Phone

Email

Branch of Service

Rank

Military Occupational Specialty or Rate

Are You Still on Active Duty?
yesno

What is your planned ETS date?

Did You Receive an Honorable Discharge?
yesno

Discharge Date (if applicable)

Was/Were Your Injury(ies) a Result of
CombatAccidentIllness

Date of Injury

Did You Receive a Purple Heart?
yesno

Is Your Injury
PermanentTemporary

What is Your VA Disability Rating?

What is Your Military Disability Rating?

Can You Provide Proof of Your Injury if Needed?
yesno

Military Medals Awarded

Circumstances Surrounding Your Injury(ies)

Types of Injury(ies) - Please be Specific

Medications Currently Taking: Prescribed and Non-Prescribed

Any Addictions or Allergies?

Legal Convictions (felonies or misdemeanors) or Issues? Please be Specific

Tell Us About Yourself

Interests or Hobbies - Please List

Interests Before Combat - Please List

Other Information You Feel May Be Important

In What Areas Are You Looking for Help?

How Did You Hear About OHD?

If inquiring about financial assistance, Our Heroes Dreams does not release funds directly to the individual but to corporations, utility companies, mortgage holders, etc. You may be asked for billing account information as well as bank statements to determine eligibility or the need for budgetary counseling.