Application For Extracurricular Assistance

1Personal Information

2Military Information

3Assistance Requested

4Family Information

5Financial Information

6Terms of Application

Service Member Name*
First Last
Service Member Work Email*
Service Member Personal Email*
Last Four of Service Member Social Security Number*
Service Member Date of Birth*
MM slash DD slash YYYY
Service Member Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Service Member Primary Phone*
Alternate Phone

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Select the Option that best reflects your military status:*
- Active Duty Military
- Reservist / M-Day National Guard
- Purple Heart Recipient Post 9/11
- Combat Action Badge or Equivalent Post 9/11
Current Military
Pay Grade*
*Effective May 15, 2019, the rank E-6 no longer qualifies for financial assistance.
Military Branch*
Command*
Stationed:*
- CONUS
- OCONUS
Please keep in mind you must be stationed in Arizona and reside in Arizona to qualify for assistance.
LES*
Max. file size: 128 MB.
Front of Military ID*
Max. file size: 128 MB.
Current Orders*
Max. file size: 128 MB.
Most recent orders (ie. AT, ADOS, AGR, Schools, etc.)
DEERs*
Max. file size: 128 MB.
We require your DEERs to see a list of dependents.
School Registration Document with Parent/Guardian & Child Name*
Drop files here or

Max. file size: 128 MB.
We require a school enrollment document that includes the parent/guardian and child's name.
Purple Heart Recipient
When and where were you wounded?*
DD214*
Max. file size: 128 MB.
Purple Heart Certificate*
Max. file size: 128 MB.
One Page VA Rating*
Max. file size: 128 MB.
School Registration Document with Parent/Guardian & Child Name*
Drop files here or

Max. file size: 128 MB.
We require a school enrollment document that includes the parent/guardian and child's name.
Combat Action Badge or Equivalent Recipient
DD214*
Max. file size: 128 MB.
Combat Action Badge or Equivalent Certificate*
Max. file size: 128 MB.
Drivers License*
Max. file size: 128 MB.
School Registration Document with Parent/Guardian & Child Name*
Drop files here or

Max. file size: 128 MB.
We require a school enrollment document that includes the parent/guardian and child's name.

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Which option best reflects your Extracurricular Assistance request?*
- School program/activity cost
- Reimbursement for the cost of equipment, gear or wardrobe, or other essentials needed for their extracurricular activity
School Program/Activity Cost
Describe the need.*
Where is this assistance going to be applied? How will your children and family benefit from the assistance? Please describe what the assistance is paying; an invoice for the program or a receipt for equipment necessary for your student to participate.
Upload School's Extracurricular Invoice*
Drop files here or

Max. file size: 100 MB.
Invoice must be addressed to the student and/or parent. If your application is approved, payment will be made directly to the invoice recipient. Invoice MUST include vendor's full name and address. We cannot process the application without it. We will help with costs for the following programs: Uniforms/shoes/gear for sports, music, and choir, Costumes/shoes for dance, drama, and cheer, Instruments for choir, music, and band, & tutoring fees!
Reimbursement for the cost of equipment, gear or wardrobe, or other essentials needed for their extracurricular activity
Describe the need.*
Where is this assistance going to be applied? How will your children and family benefit from the assistance? Please describe what the assistance is paying; an invoice for the program or a receipt for equipment necessary for your student to participate. If available, please provide a link to payment.
Upload Receipt for Extracurricular Activity*
Drop files here or

Max. file size: 100 MB.
-Reimbursement receipts must be no older than 7 days prior to the submission date NO EXCEPTIONS. Receipts must be from a reputable establishment and items on the receipt must reflect purchase for the student's extracurricular activities. -Examples of an acceptable assistance request are; the cost of the program, uniforms for sports, music, and choir, costumes for dance, drama, and cheer, instruments for choir, music, and band, & tutoring fees!
Our Extracurricular assistance is a one-time grant. Previously receiving financial assistance does not disqualify you from receiving this. Funding amount is based on status ie. CONUS, OCONUS, reservist, etc.

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Spouse First Name
Spouse Last Name (if different from applicant)
Last Four of Spouse Social Security Number*
Spouse Date of Birth*
MM slash DD slash YYYY
Child's Name (1)
First Last
Age of Child 1
Please enter a number from 0 to 18.
Child's Name (2)
First Last
Age of Child 2
Please enter a number from 0 to 18.
Child's Name (3)
First Last
Age of Child 3
Please enter a number from 0 to 18.
Child's Name (4)
First Last
Age of Child 4
Please enter a number from 0 to 18.
Child's Name (5)
First Last
Age of Child 5
Please enter a number from 0 to 18.
Child's Name (6)
First Last
Age of Child 6
Please enter a number from 0 to 18.

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Monthly Income
Base Pay*
Please enter a number greater than or equal to 0.01.
Based off your most current LES. Applications with entries that do not match the LES uploaded or entries of $0.00 will not be pushed forward.
BAH*
BAS*
Family Separation Allowance*
Hazardous Duty Pay*
VA Benefits*
Disability Benefits*
Child Support Received*
Civilian Income (Guard/Reserve/PH Recipient)*

Please enter 0 if you are not receiving any civilian income
Spouses Income*
Please enter 0 if your spouse is not working or if you do not have a spouse
Other Income
Other
TOTAL INCOME*
Civilian Pay Stub: If you do not have a civilian pay stub skip this.
Max. file size: 128 MB.
Spouse's Pay Stub
Max. file size: 128 MB.
TOTAL*

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I understand that:
1. The disclosure of this information is voluntary.
2. All information requested will be used only for determining eligibility for assistance.
3. The failure to provide all requested information will result in denial of application.
4. This program is only currently available to Arizona residents.
5. To qualify for financial assistance as a current service member I must be rank E-5 or below.
6. To qualify for financial assistance as a wounded warrior through MAM I must have received a Purple Heart or Combat Action Badge or Equivalent.
7. Military Assistance Mission may investigate my credit history and/or bank account information as related to determination for the grant eligibility.
8. All financial assistance will be issued directly to payee. MAM will not deposit money into a bank account.
9. I agree to the terms and conditions of this application as set forward above*
  - Yes
  - No
10. I certify that the information provided on this application is complete, true and correct.*
  - Yes
  - No
11. Occasionally, we ask a family we have helped to provide a testimonial. Please indicate below if you would be willing to be considered for this. Answering yes does not mean you will have to participate - it simply indicates potential interest.
  - Yes, I am willing to be considered
  - No, I would not like to be considered
  See here for an example: Testimonial
12. Did you upload all the required documents?*
  
  You must answer YES to this question to be eligible to receive assistance.
13. Electronic Signature*
  
  Enter your name in the field certifying that everything in this application is true and you understand the terms of the application.

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Please note: THIS FORM WILL NOT WORK IF BEING COMPLETED ON A GOVERNMENT COMPUTER OR A CELL PHONE. Also, when submitting LES, Military ID and Current Orders there may not be a confirmation of attachment. If these documents are missing, we will notify you of needed items.

*ALL APPLICATIONS submitted outside of normal business hours (Tuesday-Friday: 8AM – 3PM) will be processed on MAM’s next business day.

Application For Extracurricular Assistance

Current Military

Purple Heart Recipient

Combat Action Badge or Equivalent Recipient

School Program/Activity Cost

Reimbursement for the cost of equipment, gear or wardrobe, or other essentials needed for their extracurricular activity

Monthly Income