Support Our Troops And Their Families

USA Cares Assistance Request Form:

USA Cares will protect your privacy and dignity.

USA Cares personnel may contact the listed person on your application to verify your military status.

If it is found that you have not been truthful, USA Cares will not assist you, and will not consider any future requests to assist you.

USA Cares does not provide assistance with the following:

Credit card payments
Bills resulting from excessive use
Vehicle repair costs that exceed Blue Book value of the vehicle
Cosmetic repairs to homes or vehicles
Travel needs
Any medical or dental procedures
Check cashing facility bills
Business expenses
Family debt repayment
Education expenses for children or adults
Legal fees (child custody, divorce, separation, traffic violations, travel visa)
Airline Travel
Permanent Change of Station (PCS) moves
Deductibles
Reinstatement of repossessed vehicles
Crisis resulting from criminal activity (UCMJ action)

Service Members who have been discharged for any honorable reasons within the last 2 years will be considered for eligibility, particularly if they have been in a medical hold status, or pending VA determination of disability. This will apply to essential quality of life issues only. Verification of DD214 will be required.

Please fill out the following information,
Contact Information (Requester)
* First Name:
* Last Name:
* Relationship To Service Member:
* Service Member's Phone Number:

* Service Member's First Name:
* Last Name:
* Marital Status:
* Number of children in home, with ages:
* Home of Record:
* Branch:
* Service Member Status, select all that apply:		Spouse/Family Member Active Military Demobilized Mobilized Injured/Med Hold Injured/Home Medically Retired Medically Discharged: Severance Pay? Yes No Deployed - Enter dates of deployment: Enter deployed location: Veteran Retired Widow/Widower ETS - Enter date: Purple Heart Recipient
* Unit Assigned:
* Unit Phone Number:
* Unit Contact Person:
* Home Address:
* City:
* State:
* ZIP Code:
Current Email Address:
* Please select all other agencies that you have contacted:		AER Red Cross Local Church Food Banks VFW Unmet Needs Operation Homefront Other - Please list:
* Were you assisted?		Yes No
* Are you receiving Public Assistance?		Yes No

USA Cares provides assitance with quality of life items (food, shelter, primary vehicle repairs and payments.)

* IMMEDIATE EMERGENCIES		Food Eviction Foreclosure Power Water
Summary of Need:
* Dollar Amount:
* Cause of Hardship:

* Special medical needs:		- If Yes, please explain:
* Are you responsible for the care of any relatives?:		Are they Active Duty dependents: No Yes
* Are you a homeowner?:
* Is spouse seeking employment?:

You will be asked to provide estimates, receipts, or bills for the assistance you are requesting. When sending an LES, please black out the rank, bank deposit information and all but the last four of the Social Security number. Fax all paperwork to: 1-866-533-0426

*Where did you hear/read about USA Cares?:
*Full Name of Requester:		*Required Field!