EDUCATION ASSISTANCE PROGRAM (EAP)

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 Country
Primary Phone*
Alternate Phone
Are you attending college in-person or online?*
- In-Person
- Online
University or College Name*

Select the Option that best reflects your military status:*
- Post 9/11 Veteran- Purple Heart recipient or Combat Action Badge recipient
- Active or Reserve
Military Branch*
Paygrade*
Purple Heart Recipient*
Combat Action Badge or Equivalent Recipient*
Required Documents
School Invoice: Must show applicant's name, student ID number, school billing address*
Drop files here or
Max. file size: 256 MB.
You should have received this from the school stating that you are enrolled. We need the most complete version of this document to pay your bill.
Orders*
Drop files here or
Max. file size: 256 MB.
Please submit your most recent orders.
LES*
Drop files here or
Max. file size: 256 MB.
DD214*
Drop files here or
Max. file size: 256 MB.
Military ID*
Drop files here or
Max. file size: 256 MB.
Active Military upload your military ID
State ID or Veteran ID*
Drop files here or
Max. file size: 256 MB.
Post 9/11 Veterans upload your state or veteran ID

Marital Status
- Single
- Married
Spouse First/Last Name*
Last Four of Social Security Number*
Date of Birth*
MM slash DD slash YYYY
Children Information
Please leave this section blank if you do not have children.
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.

Bills
Please select the bills that you would like MAM to assist you with.
Currently the cap for assistance is $1000 per request. Choose the bills that you need help with and explain why in the box below.
School Invoice*
Textbooks*
School Parking Fees (If applicable)*
Rent for School Living ONLY*
Total*
Please provide a brief description of why you are seeking assistance.*
Upload Bills SCREENSHOTS WILL NOT BE ACCEPTED and MUST SHOW THE APPLICANT'S NAME.*
Drop files here or
Max. file size: 20 MB.
Please upload any bill(s) you would like to be considered. SCREENSHOTS WILL NOT BE ACCEPTED. BILLS MUST INCLUDE YOUR NAME, YOUR ACCOUNT NUMBER AND THE MAILING ADDRESS OF THE LIENHOLDER. We cannot guarantee all bill will be paid.

I 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 eligibility
Military 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
- No
I certify that the information provided on this application is complete, true and correct.*
- Yes
- No
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
- No
Electronic Signature*
Enter your name in the field certifying that everything in this application is true and you understand the terms of the application.

Required Documents