Apply for Assistance

Am I Eligible? My North Carolina Connection.*
To be eligible for a grant from the North Carolina Heroes' Fund, you must have a North Carolina Connection.
- I am a veteran and North Carolina native
- I am a veteran and my current permanent residency is in North Carolina
- I am associated with a North Carolina Guard or Reserve unit
- I am Active Duty stationed in North Carolina
Am I Eligible? My Financial Hardship*
To be eligible for a grant from the North Carolina Heroes' Fund, your hardship must be connected to your military services.
- I suffered an injury during a recent deployment which impacted my financial situation
- VA Disability payments have not yet began
- I have a disability, but I am still waiting for a rating to be service-connected.
- My family had an unusual financial strain while I was deployed
- My financial hardship is directly related to my military service, but not one of the categories above. I will provide extensive detail in the Financial Hardship section of the application.
Information and Documents
Below you can upload documents you will need to support your application process. Please take a few moments to gather all of the following before submitting your application. The more information you provide us, the more efficently we can process your application.
Proof of Services*
DD214 or similar
Accepted file types: jpg, pdf, Max. file size: 20 MB.
HIPPA (Medical Release Form)*
DOWNLOAD HIPPA FORM HERE
After you download, please sign and upload the form below.
Accepted file types: jpg, pdf, Max. file size: 20 MB.
Documentation supporting combat related injury
Accepted file types: jpg, pdf, Max. file size: 20 MB.
Medical Documentation
If hardship is medical related. Medical Records are not required, but are helpful in evaluation of application of hardship is due to injury.
Accepted file types: jpg, pdf, Max. file size: 20 MB.
Monthly Bills
Please provide us copies of all monthly bills, in particular those are you are expecting assistance with.
Accepted file types: jpg, pdf, Max. file size: 20 MB.
Monthly Bills 2
Please provide us copies of all monthly bills, in particular those are you are expecting assistance with.
Accepted file types: jpg, pdf, Max. file size: 20 MB.
Monthly Bills 3
Please provide us copies of all monthly bills, in particular those are you are expecting assistance with.
Accepted file types: jpg, pdf, Max. file size: 20 MB.
Monthly Bills 4
Please provide us copies of all monthly bills, in particular those are you are expecting assistance with.
Accepted file types: jpg, pdf, Max. file size: 20 MB.
Recent Photograph
Accepted file types: jpg, pdf, Max. file size: 20 MB.
Recent Photograph 2
Accepted file types: jpg, pdf, Max. file size: 20 MB.

Contact Information
Name
First Last
Age
Current Address
Street Address Address Line 2 City State ZIP Code
Hometown/Base
If different than the address listed above.
Email
Enter Email Confirm Email
Main Phone*
Cellular Phone
Alternate Contact
Name and Phone of an alternate contact for you.
Describe your Family and Marital Status
Marital Status
- Single
- Married
- Separated
- Widowed
- Divorced
Number of Children
Living with you, or for which you are financially responsible.
- 1
- 2
- 3
- 4 or more
Your Veterans Administration Contacts
VA Case Managers can be very helpful in the application process. They get to know your story and can help us understand your financial hardship.
Do you have a VA Case Manager with whom you currently work?
Name of VA Case Manager
VA Case Manager Phone
Vase Case Manager Email

Military Service Information
We honor your military service. Tell us about it.
Current or Last Military Rank and Status
Service Branch
Discharge Date
If applicable
Years of Military Service
Current/Most Recent Unit & Location
Location(s) and Date(s) of Overseas Service
Primary Specialty/Role
Describe your discharge conditions*
If your discharge was under General or Dishonorable conditions, it may negatively impact your eligibility. You should provide with your application a description of any unusual circumstances related to your discharge.
- Honorable
- General
- Dishonorable
- Not Discharged - Still Serving
Name of Current or Most Recent Commanding Officer or NCO
Contact Information for Commanding Officer or NCO:

Financial Hardship Information
What Caused Your Service-Related Financial Hardship
What Caused Your Financial Hardship?
Describe For Us:
• If you were injured, how and where did it occur?
• Where there expenses associated with injury?
• What financial difficulties occurred due to service?
• Was your hardship related to your discharge from military & transition to civilian life?

Please provide as many details as possible. If more room is needed, please feel free to continue explanation on another page.
Describe Hardship Need – How much are you requesting to help your situation?
We limit our help to $1500 or less. With what bills / debt / expenses are you requesting assistance?
Do You have a service-connected injury / disability?
- Yes
- No
If you have a disability, what is your rating?
In percentage
Please enter a number from 0 to 100.
Have you been diagnosed with PTSD?
- Yes
- No
If you have PTSD, what is your GAF score?
Please enter a number from 0 to 100.

Financial Disclosure Information
What is Your (Include Your Spouse’s) Monthly Income
Monthly Income
Current Monthly Income From Current Job (after taxes) or Unemployment Income Monthly Veterans Benefits / Retirement Income Spouse’s Monthly Income Monthly Disability Payments
Total Monthly Income
List ALL Your Monthly Expenses
Car Payment Mortgage or Rent Car Insurance Water Power/Electric Phone Other Other
Total Monthly Expenses
Describe any financial assistance you have received from your base or unit
Describe any financial assistance you have received service related support agencies such as Army Community Service, Navy Fund, Army Emergency or a similar agency?

Summary Page
Please check all of the following boxes to indicate you agree with all of the following statements:*
- I certify that all of the information provided is accurate to the best of my knowledge.
- I understand that this application will not be considered unless all requested information is provided and can be easily verified.
- I understand and agree that the North Carolina Heroes’ Fund may display a personal profile on its website so that potential donors can understand examples of our recipients.
- I understand that the North Carolina Heroes’ Fund is under no obligation whatsoever to provide financial support regardless of whether my application falls within its guidelines. I agree to hold the North Carolina Heroes’ Fund harmless pertaining to all issues concerning my application.
Name
This field is for validation purposes and should be left unchanged.

If any of these situations apply to you?

Application for Financial Hardship Grant
Things You Can Do To Help Your Chance of Getting a Grant:

Step 1 of 6

Information and Documents

Contact Information

Describe your Family and Marital Status

Your Veterans Administration Contacts

Military Service Information

Financial Hardship Information

Financial Disclosure Information

Summary Page

Current Monthly Income From Current Job (after taxes) or Unemployment Income	Monthly Veterans Benefits / Retirement Income	Spouse’s Monthly Income	Monthly Disability Payments

Car Payment	Mortgage or Rent	Car Insurance	Water	Power/Electric	Phone	Other	Other

Apply for Assistance

If any of these situations apply to you?

Application for Financial Hardship Grant Things You Can Do To Help Your Chance of Getting a Grant:

Step 1 of 6

Information and Documents

Contact Information

Describe your Family and Marital Status

Your Veterans Administration Contacts

Military Service Information

Financial Hardship Information

Financial Disclosure Information

Summary Page

Application for Financial Hardship Grant
Things You Can Do To Help Your Chance of Getting a Grant: