Application for Financial Assistance

Military Status Eligibility Quiz*
Please select one of the following options to continue with the application. Applicants who do not meet one of the listed criteria will not be eligible to proceed.

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*
Service Member Gender*
- Male
- Female
- Prefer not to say
Service Member Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Service Member Primary Phone*
Alternate Phone

Have you applied for financial assistance with Military Assistance Mission before? We are a one-time assistance program. If you answer yes to this question your application will NOT be considered.*
We are a one-time assistance program. If you answer yes to the question your application will NOT be considered.
Bill Category: General Requirement for All Bills: MAM requires full copies of all submitted bills to be considered for assistance. Mobile screenshots or partial images will not be accepted. Each document must clearly display the applicant’s name, account number, and lienholder information where applicable.*
- Rent: Full copies of the lease must be submitted. The document must clearly display the landlord’s name and address. (If you receive BAH, that amount will be deducted from rental assistance.)
- Mortgage: Full copies of mortgage statements must be submitted. Each document must clearly display the lender’s name, address, and full loan or account number. (If you receive BAH, it will be deducted from your mortgage assistance.)
- Utilities (Water, Sewer, Electric/Gas) Full copies of current utility bills must be submitted. Each document must clearly display the applicant’s name, service address, and full account number. *excludes internet and phone
- Car Payment: must include lienholder name, address and full account number.
- Car Insurance: Full copies of the insurance documents must be submitted. The document must clearly display the lienholder’s name, address, and full account number.
- Food
These are the only categories for which MAM provides financial assistance. All bills for which assistance is requested must be uploaded in order to be considered. MAM does not provide assistance for credit cards, internet, phone, or appliance expenses. Please note: Bills set to auto-pay are not eligible for assistance.
Is your financial request caused by a military pay issue?*
Please provide a brief description of why you are seeking assistance. ⚠️ In the event of a government shutdown, MAM will limit financial assistance to food only.*
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. Upload Bills: Upload complete bills only. Unreadable images, partial photos and mobile screenshots will not be accepted.*
  Drop files here or
  Max. file size: 256 MB.
  Bill Submission Requirements
  •Full Copies Required: MAM requires full copies of all bills to be considered for assistance. Mobile screenshots of bills will not be accepted. Each document must clearly display your name, account number, and lienholder information.
  •Autopay Payments: If your bills are set to autopay and your application is approved, please notify the lienholder that a payment is forthcoming to prevent duplicate deductions from your account.
  •You will be notified of the outcome of your application via email.
  •Basic Allowances (BAH): If you receive BAH, it will be deducted from your rental assistance.
  •Program Limits: Our programs have a cap on assistance to ensure support can be provided to as many families as possible.
  •Coverage Period: Assistance covers one recent month per bill submitted with your application.
10. This is a one time assistance mission. If you have applied for and received assistance previously, you will not qualify for assistance again.

Do you have a spouse?*
- Yes
- No
Spouse Information
Spouse First Name
Spouse Last Name (if different from applicant)
Last Four of Spouse Social Security Number*
Spouse Date of Birth*
Children Information
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.

Monthly Income
Do not enter the $ (dollar sign) when entering numbers. It will appear automatically. Doing so could cause your application to not go through.
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*
*IF YOU RECEIVE BAH, IT WILL DECUCTED FROM YOUR RENTAL ASSISTANCE.
BAS*
Family Separation Allowance*
Hazardous Duty Pay*
Sea 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
Additional Income
Other
TOTAL INCOME*
If your total monthly income exceeds $4,395, you do not meet the qualifications for MAM programs. Income requirements are determined by Arizona poverty guidelines.
I certify that the income information provided on this application is true and correct.*
- Yes
- No
Current Civilian Pay Stub*
Max. file size: 256 MB.
VA Benefits Letter*
Max. file size: 256 MB.
Current Spouse's Pay Stub*
Max. file size: 256 MB.
Monthy Expenses
Do not enter the $ (dollar sign) when entering numbers. It will appear automatically. Doing so could cause your application to not go through.
Rent / Mortgage*
Electric Bill*
Water/Waste Bill*
Phone Bill*
Gas Bill*
other Utilities*
Food*
Vehicle*
Insurances*
Childcare*
Child support paid*
Credit Card Balances*
Miscellaneous*
TOTAL EXPENSES*
TOTAL*

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 and monthly income cannot exceed $4,395
6. To qualify for financial assistance as a wounded warrior through MAM I must have received a Purple Heart or Combat Action Badge, and monthly income cannot exceed $4,395
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.
12. Electronic Signature*
  Enter your name in the field certifying that everything in this application is true and you understand the terms of the application.

1 Application For Needs

Current Military

Purple Heart Recipient

Combat Action Badge or Equivalent Recipient

Veteran

Spouse Information

Children Information

Monthly Income

Monthy Expenses