Eagle OPS Hand UP Emergency Grant Application

Eagle OPS HAND UP Emergency Funds Request

As a mission of Operation HAND UP, and contingent upon available funds, Eagle OPS provides limited assistance for emergency needs that could otherwise negatively affect a service member or veteran in their transition home. Requests will be reviewed and requestee will be notified IF the Hand-UP Grant is approved or if further information is needed. Eagle OPS reserves the right to approve or deny requests at the discretion of the board of directors and availability of funds on a case by case basis. Please fill out the form below with as much detail as possible, the review board needs enough information to help approve the Hand UP Grant.**NOTE: Eagle OPS does not make any payment directly to any individual. Eagle OPS only considers supporting its veterans through payment to qualified vendors, or other providers of goods or services that are essential to the welfare of the veteran.**
Has this veteran received a Hand-Up Grant from Eagle OPS in the past 12 months?*

YESI DON'T KNOWNO
Please make a selection:*

I am with an organization / agency making a request on behalf of a veteran / service member.I am the veteran / service member making the request.
Organization / Agency Contact Information

Please provide information related to the agency in this section.
Name:

First NameLast Name
Agency / Organization:
Agent Email
example@example.com
Agent Phone Number
Please enter a valid phone number.
Please upload a Release of Information (ROI) signed by the service member/veteran and an authorized representative of your organization.

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Service Member / Veteran Information

Please list veteran / service member information in this section.
Veteran / Service Member Name:*

First NameLast Name
Branch of Service:*
Veteran Phone Number:*
Please enter a valid phone number.
Date of Birth:*

YearMonthDay
Please enter your date of birth (year-month-day)
Veteran Email Address:*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Proof of Service Upload*

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Valid Photo ID*

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Hand-UP Request

Please provide as much information as possible regarding funds being requested in this section.
Have you contacted any other organizations to include veteran service organizations for support?*

YesNo
Please provide the name of the agency or organization that referred you to us if applicable:*
Type N/A if not applicable.
Amount of Request;*
Example : 240.00
Request for:*

Utilities AssistanceAuto Repairs or insuranceHotel StaysRent or mortgage assistanceAdaptive home repairs or updatesJob Placement assistance (training costs, fuel etc.)Legal assistanceTravel AssistanceOther type of assistance not listed
Please list the organization(s) you have contacted for support if applicable.*
Type N/A if not applicable
What circumstances lead to this need for assistance?*
Please provide as much detail as possible so we can better understand your circumstances.
If granted assistance from Eagle OPS, what steps will you be or are you taking to ensure that you will not need further assistance with this bill/circumstance?*
Please provide as much detail as possible. This helps our team make a decision.
Payee Information

Eagle OPS does not make any payment directly to any individual. Eagle OPS only considers supporting veterans through payment to qualified vendors, or other providers of goods or services that are essential to the welfare of the veteran. If approved, Eagle OPS will only provide funding directly to the organization or business providing assistance. Please provide the necessary information in this section.
Payee:*
Payee address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Payee Phone Number*
Please enter a valid phone number.
Payee Email
example@example.com
Payee Website*
example: www.eagleops.org
Name on Account*

First NameLast Name
Account Number*
Type N/A if not applicable
Bill / Document Upload:*

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Please upload a supporting document reflecting what you owe.
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I understand that my request will be reviewed and a decision will be made within 2 -4 business days. I understand that I may be contacted to provide additional information. I understand that Eagle OPS reserves the right to approve or deny requests on a case by case basis at the discretion of the board of directors.*

SIGN WITH YOUR FINGER IN THE BOX. Clear
Should be Empty:

Eagle OPS HAND UP Emergency Funds Request

Organization / Agency Contact Information

Service Member / Veteran Information

Hand-UP Request

Payee Information