Military Warriors Support Foundation | Combat-Wounded Veterans, Gold Star Families
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Message From George Strait
(Z) Transportation4GoldStars
Step
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Before proceeding, Please be sure you meet all of these basic requirements to apply:
Before proceeding, you must meet all requirements below
(Required)
Hero was KIA during combat or combat training during any American conflict
Can Obtain Vehicle Insurance
Does not have more than one vehicle loan/lease in the household
If you have any questions about this application, please email us - Transportation@militarywarriors.org
Please be aware, that with your successful completion of this application, you will required to submit documentation in order to participate within the program.
The first step in this process is the documents listed below. If you do not submit them after you complete this application, you cannot be found eligible.
DD2064, Certificate of Death
DD1300, Report of Casualty
Purple Heart Certificate and Orders(Posthumous)
Bronze Star Certificate and Orders (Posthumous)
Submitted Documents Understanding
(Required)
Check the box to verify you understand. If you have further questions, you can finish the application and email us at info@militarywarriors.org.
I understand.
Applicant Information
Surviving Spouse's Full Name
(Required)
Surviving Spouse's Date of Birth
(Required)
Month
Day
Year
Cell Phone
(Required)
Home Phone
(Required)
Email
(Required)
Address
(Required)
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Current Family Information
Current Marital Status:
(Required)
Single
Married
Divorced
Widowed
Name of Spouse
(Required)
Spouse Primary Phone Number
(Required)
Spouse Date of Birth
(Required)
Month
Day
Year
Hidden
(X)If Married, how many years?
Spouse Email
(Required)
List ALL members who reside in your home (including yourself)
1
Name
(Required)
First
Last
Occupant Date of Birth #1
(Required)
Month
Day
Year
Relationship
(Required)
Hidden
Age #1
Please enter a number from
0
to
99
.
2
Occupant #2
First
Last
Occupant Date of Birth #2
Month
Day
Year
Hidden
Age #2
Please enter a number from
0
to
99
.
Relationship #2
3
Occupant #3
First
Last
Occupant Date of Birth #3
Month
Day
Year
Hidden
Age #3
Please enter a number from
0
to
99
.
Relationship #3
4
Occupant #4
First
Last
Occupant Date of Birth #4
Month
Day
Year
Relationship #4
Hidden
Age #4
Please enter a number from
0
to
99
.
5
Occupant #5
First
Last
Occupant Date of Birth #5
Month
Day
Year
Hidden
Age #5
Please enter a number from
0
to
99
.
Relationship #5
6
Occupant #6
First
Last
Occupant Date of Birth #6
Month
Day
Year
Hidden
Age #6
Please enter a number from
0
to
99
.
Relationship #6
We ask that you complete the following questions which will help MWSF in pursuit of additional funding for its programs through grants and sponsorships. Your answers will not impact your application process. The data collected is protected in accordance with the Privacy Act (93-579). Unauthorized disclosure of this information constitutes a violation of the Privacy Act. You are not required to provide this information, but are encouraged to answer honestly, so that future applicants may continue to benefit from our programs.
Applicant's Gender?
(Required)
--
Female
Male
Other
Decline to answer
Which race/ethnicity best describes you?
(Required)
--
Non-Hispanic White or Euro American
Black, Afro-Caribbean or African American
Latino or Hispanic American
East Asian or Asian American
South Asian or Indian American
Middle Eastern or Arab American
Native American or Alaskan Native
Decline to answer
What is the highest degree or level of school you have completed? If currently enrolled, highest degree received?
(Required)
--
Some high school, no diploma
High school graduate, diploma or GED
Some college credit, no degree
Trade/technical/vocational training
College graduate
Some post-grad work
Post-grad degree
Decline to answer
Hero Military Information
1. Please provide a brief history of your spouse's military career, include tours, awards given or commendations received. (*Please note, upon further consideration, supporting documentation for all listed tours, awards and decorations will require supporting documentation. A copy of your spouse's' DD1300 and DD2064 will be required. Please have available so you may deliver promptly upon request. False claims of valor will not be tolerated.)
Hero's Branch of Service
(Required)
US Army
US Air Force
US Marine Corps
US Navy
US Coast Guard
US Space Force
Did the Hero receive a Purple Heart?
(Required)
Yes
No
Hero's Full Given Name
(Required)
Hero Date of Birth
(Required)
Month
1
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5
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12
Day
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1932
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1930
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1926
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1924
1923
1922
1921
1920
Hero's Rank when KIA
(Required)
Date Hero was KIA
(Required)
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
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2015
2014
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2012
2011
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1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Which country did it occur?
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
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
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Military History
(Required)
Awards
(Required)
Purple Heart
Medal of Honor
Silver Star
Army Distinguished Service Cross
Navy Cross
Air Force Cross
Coast Guard Cross
Distinguished Flying Cross
Bronze Star Medal w/ Valor
Bronze Star Medal
Commendation Medal w/ Valor
Commendation Medal
Achievement Medal w/ Valor
Achievement Medal
Air Medal w/ Valor
Air Medal
Air Force Combat Action Medal
Combat Infantryman Badge
Combat Action Badge
Combat Medic Badge
Combat Action Ribbon
Afghanistan Campaign Medal
Inherent Resolve Campaign Medal
Iraq Campaign Medal
Vietnam Service Medal
Global War on Terrorism Service Medal
Global War on Terrorism Expeditionary Medal
NONE LISTED
Please describe the circumstances that lead to the Hero’s combat related death, dates, how it occurred.
(Required)
Financial Information
Annual Household Income
(Required)
Under $20,000
$20,000 - $30,000
$30,000 - $40,000
$40,000 - $50,000
$50,000 - $75,000
$75,000 - $100,000
$100,000 - $150,000
$150,000 or more
Household Income Details
(Required)
(Please list ALL current household income, including amounts and sources. (i.e. Hero and Spouse Salary, Disability, Social Security, Child Support, Retirement, etc.): explain why)
Do you have any debt?
(Required)
Yes
No
*If Yes, please explain below.
Please provide type, total unpaid balances and whether or not you are making payments
(Required)
Are you, or an immediate family member, currently employed with any of the below financial institutions? Must check one of the below boxes.
(Required)
Chase Bank
Bank of America
Wells Fargo
US Bank
GMAC
SunTrust
None Listed
Bank Relationship
(Required)
Bank Position
(Required)
Transportation Information
Valid Drivers License Number
(Required)
State of Drivers License
(Required)
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Expiration of Drivers License
(Required)
MM slash DD slash YYYY
If offered in your area, would you be willing to receive an Electric Vehicle?
(Required)
Yes
No
If offered in your area, would you be willing to receive an Hybrid Vehicle?
(Required)
Yes
No
What type of vehicle/size does your family need, if you are found eligible for this program?
(Required)
**The type of vehicle you enter, is not guaranteed.
Do you, or a member of your family, require special modifications in the vehicle?
(Required)
Yes
No
Special Modifications Needed in Vehicle(Be Specific)
(Required)
Do you or your spouse own a registered motor vehicle?
(Required)
Yes
No
Vehicle #1
Is there a lien on the vehicle?
(Required)
Yes
No
Loan Provider
(Required)
Payoff
(Required)
Current on your payments?
(Required)
Yes
No
If No, how far behind?
(Required)
Year
(Required)
Make
(Required)
Model
(Required)
VIN Number
(Required)
Vehicle #2
Do you have another vehicle?
(Required)
Yes
No
Is there a lien on the vehicle?
(Required)
Yes
No
Loan Provider
(Required)
Payoff
(Required)
Current on your payments?
(Required)
Yes
No
If No, how far behind?
(Required)
Year
(Required)
Make
(Required)
Model
(Required)
VIN Number
(Required)
Have you ever received a vehicle or home from anyone, including Military Warriors Support Foundation?
(Required)
Please mark yes, if you received a home or vehicle and sold it or gave it away.
Yes
No
Who did you receive it through and when did you receive it?
(Required)
Did you return this gift?
(Required)
Yes
No
If yes, why was the vehicle returned?
(Required)
Are you currently contracted in a vehicle lease agreement?
(Required)
Yes
No
(Please give the date your lease is up and penalties for breaking the lease)
Lease Year
(Required)
Lease Make
(Required)
Lease Model
(Required)
Lease VIN Number
(Required)
Lease End Date
(Required)
Month
1
2
3
4
5
6
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8
9
10
11
12
Day
1
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Year
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2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
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1972
1971
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1969
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1966
1965
1964
1963
1962
1961
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1959
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1957
1956
1955
1954
1953
1952
1951
1950
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1948
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1932
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1930
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1928
1927
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1923
1922
1921
1920
List any penalties for breaking the lease
(Required)
Criminal History
Have you, or a member of your family, been charged or convicted of a crime?
(Required)
Yes
No
If Yes, are you or them currently on probation? Please explain in the field below.
(Required)
Do you, or a member of your family, have any violations on your driving record?
(Required)
Yes
No
*If Yes, please explain below.
Please note, having violations may not affect your eligibility in any way
(Required)
Impact of Vehicle
Please answer the following questions openly and honestly. This is your opportunity to tell us about you, your family and your current situation. Read questions carefully; be certain you are answering it completely.
Please tell us what receiving a vehicle would mean to you and your family. Explain how it will impact your recovery as a family.
(Required)
If selected, WHEN would you be able to receive the vehicle?
(Required)
Month
1
2
3
4
5
6
7
8
9
10
11
12
Day
1
2
3
4
5
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29
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31
Year
2023
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2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
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1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
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1941
1940
1939
1938
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1936
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1933
1932
1931
1930
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1928
1927
1926
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1922
1921
1920
Please consider this carefully and realistically
Reference Information
How did you hear about us?
(Required)
Search Engine (Google)
Facebook
Twitter
Instagram
TV Ad
Paper Ad
Friend
Event
Other
Please describe how you heard about us
(Required)
Please provide the name and phone number of 2 references that will be contacted: one Military & one Personal
Military Reference Name
(Required)
Military (Someone you served in combat with, preferably a Superior Officer or NCO)
Military Reference Phone Number
(Required)
Military Reference Notes
(Required)
Personal Reference Name
(Required)
Personal (Cannot be immediate family or person currently living with you, please indicate nature and length of relationship)
Personal Reference Phone Number
(Required)
Personal Reference Notes
(Required)
If selected for consideration, will you consent to a credit, and background checks and will provide transcript of your driving record from the Motor Vehicle Department?
(Required)
Yes
No
*Please note, a credit, background check and driving record will be mandatory before a vehicle is ultimately awarded. All credit scores and background information will be considered and an opportunity to explain any discrepancies will be provided.
Statement of Truth
(Required)
Providing false information can cause a review and change in applicant status and may affect your eligibility to participate in any MWSF program. By submitting the application, you confirm that you all the information contained in it, is truthful to the best of your knowledge. And that you give Military Warriors Support Foundation permission to contact you regarding our programs.
Agree
Disagree
Δ