Veteran'S Hardship Waiver Form (Page 3 of 3) in pdf

WARRIOR THUNDER FOUNDATION FINANCIAL ASSISTANCE FORM

MONTHLY EXPENSES

BILL

AMOUNT

BILL

AMOUNT

MORTGAGE/RENT

CHILD CARE

AUTOMOBILE(S)

CHILD SUPPORT

HEALTH/LIFE/ INSURANCE

ALIMONY

ELECTRIC

CREDIT CARD(S)

HEATING/COOLING

STUDENT LOAN(S)

WATER/SEWER

OTHER LOAN(S):

PHONE/INTERNET/TV

OTHER BILL(S):

CELL PHONE(S)

OTHER UTILITIES:

HOUSEHOLD MONTHLY INCOME

INCOME

AMOUNT

INCOME

AMOUNT

EMPLOYMENT

ALIMONY

MILITARY RETIREMENT

CHILD SUPPORT

VA COMPENSATION

STATE/FEDERAL ASSISTANCE

OTHER PENSION

OTHER:

TERMS AND CONDITIONS

THIS FORM IS ESSENTIAL TO THE REVIEW AND APPROVAL PROCESS. WE WANT TO EMPHASIZE THAT EACH APPLICATION WILL BE

REVIEWED INDEPENDENTLY AND EACH CASE WILL STAND ON ITS OWN MERIT. BY SUBMITTING THIS FORM, I UNDERSTAND AND

AGREE TO THE SUBMISSION POLICY AND THE FOLLOWING TERMS AND CONDITIONS.

I UNDERSTAND THAT PROPER STEWARDSHIP REQUIRES I PROVIDE INFORMATION TO SUBSTANTIATE MY REQUEST, INCLUDING

GOVERNMENTAL RECORDS, PRICE/INCOME INFORMATION, AND MEDICAL INFORMATION. THIS INFORMATION WILL BE KEPT

CONFIDENTIAL. I FURTHER INDICATE THAT IF THE REQUEST CANNOT BE SUBSTANTIATED, IT WILL NOT BE POSSIBLE TO

CONSIDER OR APPROVE IT.

I AGREE TO ALLOW THE WTFI TO HAVE ACCESS TO MY ACCOUNT INFORMATION FOR THE SOLE PURPOSE OF PAYMENT

REMITTANCE. I WILL SUBMIT DOCUMENTATION OF THE EXPENSES FOR VERIFICATION BY WTFI PERSONNEL.

I UNDERSTAND THAT THE WTFI ELECTS TO PAY FOR APPROVED BILLS, MERCHANDISE OR SERVICES DIRECTLY.

I UNDERSTAND THE PRIMARY PURPOSE OF THE WTFI FINANCIAL ASSISTANCE PROGRAM IS TO MEET IMMEDIATE AND URGENT

NEEDS OF THE RECENTLY ACTIVE DUTY MILITARY, RESERVE AND NATIONAL GUARD PERSONNEL, VETERANS AND THEIR IMMEDIATE

FAMILY MEMBERS.

I UNDERSTAND THAT BECAUSE DEMAND IS SO GREAT, I CAN ONLY APPLY TO THE PROGRAM ONCE EVERY TWELVE (12) MONTHS,

EVEN IF MY APPLICATION HAS BEEN DENIED.

I AGREE TO OBEY ALL THE POLICIES OF THE PROGRAM AND COMPLY WITH ANY REASONABLE DIRECTIONS WITH RESPECT TO

QUESTIONS OR CONCERNS THAT MAY ARISE.

I UNDERSTAND THAT THE WTFI MAY REQUIRE THAT I SUBMIT TO AN INTERVIEW, AND MAY REQUEST TO USE MY NAME AND THE

PARTICULARS OF THE GIFT IN PRESS AND PROMOTIONAL EFFORTS. I UNDERSTAND THAT THERE IS NO PROMISE OF

COMPENSATION FOR MY PARTICIPATION. IF I CHOOSE TO MAINTAIN CASE CONFIDENTIALITY, IT WILL IN NO WAY INFLUENCE MY

APPLICATION. THE WTFI MAY USE MY WRITTEN STATEMENTS AND DOCUMENTATION ENCLOSED AS NEEDED FOR THESE PURPOSES.

I UNDERSTAND THAT THE WTFI FINANCIAL ASSISTANCE PROGRAM IS FUNDED BY PUBLIC DONATIONS AND SUCCESS IS BASED

SOLELY UPON PUBLIC SUPPORT OF THE PROGRAM. THE WTFI FINANCIAL ASSISTANCE PROGRAM IS NOT GOVERNMENT FUNDED.

I AGREE TO HOLD THE WTFI, THEIR OFFICERS, AGENTS, AND SPONSORS HARMLESS AS A RESULT OF THIS REQUEST AND THEIR

HANDLING OF IT AND WAIVE ALL RIGHTS TO SEEK DAMAGES FROM THESE PARTIES FOR ANY LOSS, OR PERCEIVED LOSS THAT MAY

OCCUR.

Veteran'S Hardship Waiver Form Page 3

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