Application

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9th Annual Golf Classic
Veteran Relief Fund
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Veteran Relief Fund Application

Instructions:

Please complete the following information in its entirety so the Last Man Club can respond to your request in a timely manner. You will be notified if further information is required. All information will be kept strictly confidential.

Click here to download a fillable, printable pdf.

Section 1: Agency Information

* Indicates required field

Date of Request: *

Agency Requesting Funds *

Agency Contact Name *

First

Last

Agency Contact Phone *

Agency Contact Email *

Section 2: Applicant Information

Applicant Name *

Branch of Service *

Dates of Service *

Country/Countries of Service *

Does the Applicant currently reside in your county? *

Yes No

Is the Applicant currently serving in the U.S. Military? *

Yes No

Was the Applicant discharged under Honorable conditions? *

Yes No

Is the Veteran enrolled in VA healthcare benefits? *

Yes No

Section 3: Funding Request Information

Date Funds Needed By *

What other organizations/agencies are working with this veteran? *

Were other federal/state/local funding options available and/or utilized? *

Yes No

If Yes, please explain: *

Who Should Payment Be Made To? *

*The LMC does not make payments directly to individuals.

Description of Need *

How does this request benefit the Veteran moving forward? *

Is there any other information that would be pertinent to the approval of this application? *

Digital Signature *

By checking this box, you agree that this serves as your digital signature on this application.

Submit

Home
9th Annual Golf Classic
Veteran Relief Fund
- About