Application for Assistance

Application for Assistance

Please fill out the below information if seeking assistance.  One of our Assistance Specialist will be contacting you shortly.

Keep in mind, be as specific and detailed as possible.

We have helped not only using our own programs, but programs across the United States.  The more we know, the better we can get you connected to the right resources.

**Disclaimer:  Our Heroes’ Dreams does not share this information with 3rd parties or those outside of Our Heroes’ Dreams. The information obtained is only used to get you the help you need.  Our Heroes Dreams fully understands the need for confidentiality in these matters.  If requesting Financial Assistance, be advised you may be asked to provide financial records and/or attend one of our money management classes, Our Heroes Dreams does not release funds directly to the individual but to corporations, utility companies, mortgage holders, etc. **

First Name

Last Name

Middle Initial

DOB

Street Address

City

State

Zip Code

Phone

Email

Service (check all that apply)
Air-forceArmyCoast GuardMarinesNavyNational GuardLaw EnforcementFireEMTCorrections

What is Your Disability Rating? (if Any)

Types of Injury(ies) - Please be Specific

Any Addictions or Allergies?

Interests or Hobbies - (check all that apply)
HikingCampingFishingVolunteeringArcheryCaregiver SupportFundraisingAdaptive Recreation

Other Interests

In What Areas Are You Looking for Help?
PTSDAnxietyDepressionStress/Anger ManagementMoney Management/FinancialFamily SupportHousingVA AssistanceNeed a new mission in life

Other Needs

How Did You Hear About OHD?