Individual Assistance Request


		
		
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
        
          
Greater Los Angeles Chapter
Association of the United States Army
Military Assistance Fund
Service Member Name:: *
Rank First Last MI
Age:
Check One:
Army Reserve  Army National Guard Active Duty Other
Phone number:
- 
Area Code Phone Number
E-mail:
Unit Name:
Unit Location:
Reason for Request - Briefly explain what assistance you need and reasons for request (i.e. lost job, etc.):
$ Amount of Assistance Requested *
Attach copy of bill(s) or invoice(s):
Payment to be sent to:
Name:
First Last
Address:
Street AddressCityStatePostal / Zip Code
Account Number (if available):
Phone:
- 
Area Code Phone Number
E-mail (if available):
Request submitted on service member’s behalf by:
- Name:
First Last
- Organization:
- Phone:
- 
Area Code Phone Number
- E-mail:
Recaptcha Word Verification:
type_submit_reset_33 
This request is in response to GLAC’s offer to support Units/Soldiers/Families. GLAC/AUSA is a non-profit 501(c)(3) organization. 

All requests need to be supported with verification (i.e. DD-214, copy of bill, etc.). No direct cash payments to Soldiers/Veterans are made. Payments are only made to companies, etc., verified on invoices.

Request should be submitted by 3rd party individuals or organizations with direct knowledge of the service member’s situation and circumstances. Requests should not come directly from the service member.