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Grant Application
How Donations Help
Golf Tournament
Bryan's Legacy
Contact
FAQs
Donate
Apply
Eligibility Criteria
Minnesota Taxpayer or a Non-Minnesota taxpayer assigned to a Minnesota Military Unit
All branches of service-enlisted and reserve military personnel
Served in a designated Combat Zone anywhere in the world
Served after September 11, 2001
Active service or honorably discharged providing your DD214
The reason for loss of income was due to
Illness
Injury
Natural Disaster
Activation or Mobilization
Death
Nature of Incident
Date of Incident
Location of Incident
If you were injured and awarded a Purple Heart Certificate, please list the date of injury And attach a copy of your Purple Heart Certificate and a copy of the Incident Report.
Have you made previous application?
Yes
No
If 'Yes,' give date and place
*Please attach a summary statement of why you need this grant. The information you provide will help the board determine the worthiness of your needs.
Personal Information
Social Security Number
Folio No.
Last Name
Rank - First Name
Initial
Date of Birth
Permanent Mailing Address (Check Disbursement address)
City
State
Zip Code
County
E-Mail Address
*
Day Phone Number
Evening Phone Number
Military Information
Branch of Service
State of Legal Residence
Name of Home Unit and Phone
Combat Location Served
Start Date
End Date
Time Period Served
MN Unit Commander Name
Commander Phone/Email Address
Marital and Dependent Status
Marital Status
Unmarried
Married
Separated
Widowed
Minor Dependents
0
1
2
3
4
5 or more
Dependent #1
First Name
M.I.
Last Name
Social Security Number
Date of Birth
Relationship to Veteran
Dependent #2
First Name
M.I.
Last Name
Social Security Number
Date of Birth
Relationship to Veteran
Dependent #3
First Name
M.I.
Last Name
Social Security Number
Date of Birth
Relationship to Veteran
Dependent #4
First Name
M.I.
Last Name
Social Security Number
Date of Birth
Relationship to Veteran
Dependent #5
First Name
M.I.
Last Name
Social Security Number
Date of Birth
Relationship to Veteran
I am requesting a non-taxable grant, and to the best of my knowledge, certify that the above information is true and accurate. I understand BMMHF has the right to reduce the size of a grant or discontinue awarding grants whenever BMMHF deems necessary. I understand that BMMHF will award one grant per applicant but if I am injured on a later tour, I may re-apply or in the event of my death, my beneficiary may re-apply for an additional grant. BMMHF will not disclose any nonpublic personal or military information about its applicants to any third party, except to the extent BMMHF deems necessary to validate the information provided on this application. Filling out this online form indicates acceptance of the foregoing conditions.
Would you be willing to give a testimonial of our organization and photo?
Yes
No thanks
Attachments
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