Request Assistance

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Request Assistance Form

Step 1 of 5 - General Information

General Information

Name(Required)

Request Assistance Form

    General Information





    Assistance to Date

    If not, and you are eligible, a member of the coalition can assist you with registering.

    If not, a member of 211 will contact you for assistance.

    Request

    Current Financial Status

    Guidelines

    • Financial assistance is limited to $500 or less per county per month.

    • If receiving financial assistance, we do not give the funds to the veteran. We will work with creditors and pay them directly.

    • If assistance is provided, proof of military service will be required.

    • Projects are ranked according to the information provided on this form. Please give accurate details and we will review and assess the project.

    • The VA and 211 are valuable assets in our region. Working with both groups WILL be part of the plan to help you if applicable.

    • There is no cost for our services. We ask that you join the Coalition’s Facebook page and if possible, join us on future projects and Pay It Forward as we help other Veterans in Need.

    • By clicking on submit, you are sending the above information to the several members of the Coalition. They WILL NOT share this information with anyone else without your permission.

    Brad Blanchard, Director

    Great Lakes Bay Veterans Coalition

    Contact Info

    Great Lakes Bay Veterans Coalition looks forward to working with you. 

    Location

      (989) 555-5555