Individual Assistance Request

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Greater Los Angeles Chapter
Association of the United States Army
Military Assistance Fund


Service Member Name:: *
Age:
Check One:
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:
Address:
Account Number (if available):
Phone:
-
E-mail (if available):

Request submitted on service member’s behalf by:

- Name:
- Organization:
- Phone:
-
- E-mail:

Recaptcha Word Verification:

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.