Military Warriors Support Foundation | Combat-Wounded Veterans, Gold Star Families

Before proceeding, you must meet all requirements below*
- 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

Applicant Information
Surviving Spouse's Full Name*
Surviving Spouse's Date of Birth*
MM
DD
YYYY
Cell Phone*
Home Phone*
Email*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

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?*
Which race/ethnicity best describes you?*
What is the highest degree or level of school you have completed? If currently enrolled, highest degree received?*

Financial Information
Annual Household Income*
Household Income Details*
(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?*
- Yes
- No
*If Yes, please explain below.
Please provide type, total unpaid balances and whether or not you are making payments*
Are you, or an immediate family member, currently employed with any of the below financial institutions? Must check one of the below boxes.*
- Chase Bank
- Bank of America
- Wells Fargo
- US Bank
- GMAC
- SunTrust
- None Listed
Bank Relationship*
Bank Position*

Criminal History
Have you, or a member of your family, been charged or convicted of a crime?*
- Yes
- No
If Yes, are you or them currently on probation? Please explain in the field below.*
Do you, or a member of your family, have any violations on your driving record?*
- Yes
- No
*If Yes, please explain below.
Please note, having violations may not affect your eligibility in any way*

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.*
If selected, WHEN would you be able to receive the vehicle?*
Please consider this carefully and realistically

Reference Information
How did you hear about us?*
Please describe how you heard about us*
Please provide the name and phone number of 2 references that will be contacted: one Military & one Personal
Military Reference Name*
Military (Someone you served in combat with, preferably a Superior Officer or NCO)
Military Reference Phone Number*
Military Reference Notes*
Personal Reference Name*
Personal (Cannot be immediate family or person currently living with you, please indicate nature and length of relationship)
Personal Reference Phone Number*
Personal Reference Notes*

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?*
- 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*
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

Applicant Information