College BackpacksEligible applicants will receive a backpack with education essentials to assist them with their upcoming or current school year. Applicants must be currently enrolled or attending higher learning courses.Step 1 of 333%Name* First Last Email* Last Four of Social Security Number*Date of Birth* MM slash DD slash YYYY Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Primary Phone*Alternate PhoneCollege backpacks are available to those currently enrolled or attending in-person classes. Please confirm.* Yes, I am enrolled/attending in-person classes.University or College Name*School Invoice or Statement: Must show applicant's name, and confirm you are attending in-person courses.* Drop files here or Select filesMax. file size: 256 MB. Please submit the most complete version of this document.Select the Option that best reflects your military status:* Post 9/11 Veteran- Purple Heart recipient or Combat Action Badge recipient Active or ReserveMilitary Branch*ArmyMarinesAir ForceNavyCoast GuardNational GuardPaygrade*E-1E-2E-3E-4E-5Purple Heart Recipient*YesNoCombat Action Badge or Equivalent Recipient*YesNoRequired DocumentsOrders* Drop files here or Select filesMax. file size: 256 MB. Please submit your most recent orders.LES* Drop files here or Select filesMax. file size: 256 MB. DD214* Drop files here or Select filesMax. file size: 256 MB. Military ID* Drop files here or Select filesMax. file size: 256 MB. Active Military upload your military IDState ID or Veteran ID* Drop files here or Select filesMax. file size: 256 MB. Post 9/11 Veterans upload your state or veteran IDI understand that:The disclosure of this information is voluntary.All information requested will be used only for determining eligibility for assistance.The failure to provide all requested information will result in denial of application.This program is currently available to service members E-5 or below residing in Arizona OR attached to an Arizona unit OR Post 9/11 Veterans residing in Arizona.Military Assistance Mission may investigate my credit history and/or bank account information as related to determination for the grant eligibilityMilitary Assistance Mission may investigate your school information for documentation for our records and to determine your eligibility for this program.All grants will be issued directly to lienholder. MAM will not deposit money into a personal bank account.I agree to the terms and conditions of this application as set forward above* Yes NoI certify that the information provided on this application is complete, true and correct.* Yes NoOccasionally, 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 NoElectronic Signature*Enter your name in the field certifying that everything in this application is true and you understand the terms of the application.
