COMMANDER’S REFERRAL PROGRAM
1. Section Number
2. Rank
Application For Army Emergency Relief (AER)
Financial Assistance
3. SSN or AER Client ID #
4. Soldier’s Name
(Last, First, MI)
5. ETS Date
6. Unit
6a. Soldier’s Home or Permanent Mailing Address, Phone # and Email
Are you currently in Bankruptcy? ___ No ___ Yes If yes, what Chapter? ____
7. Bankruptcy Filed or Pending?
Do you intend to file Bankruptcy within the next six months? ___ Yes
___ No
8. Reason Why Assistance is Needed
(Be complete and specific. If more space is needed, continue on separate sheet)
8a.
Dependents for Whom You Furnish More Than One-Half Support (ID Card Holder):
Name
Age
Relationship
8b.
:
$
List Your Specific Emergency Financial Needs
$
Total
9.
Applicant’s Certification
Show Total
Hide Total
I hereby authorize the Department of the Army to supply any requested information contained in my official Army personnel and pay files
in connection with this assistance. I authorize the Department of the Army, or any agency, to supply my latest home address, and/or
official military address to AER whenever requested. I further understand that AER is an independent private entity, not part of the U.S.
Government. This application form, therefore, is not subject to the Privacy Act (5 U.S.C. 552a). Information provided on this application,
in some cases, will be provided by AER to the Army in order to determine eligibility for and administration of financial assistance. I
certify the information provided on this application is complete, true and correct.
9a.
9b. Date
Signature of Applicant
10. Unit Commander or First Sergeant
10a. Soldier
_______ is or
_______ is not Pending Elimination from the Army.
10b. Request Is: _______ Approved.
_______ Disapproved. Soldier has been informed of reason(s) why this request was disapproved.
10c. Requested Amount $___________
(Maximum $1,500)
10d. Approved Amount $___________
10e. Name/Rank of CDR/1SG, Signature, Phone #, and Email
10f. Date
11. AER Officer Review of the Application
11a
__ I have performed the required administrative review and Soldier is eligible for AER Assistance under Commander’s
.
Referral.
11b
__ I have performed the required administrative review and Soldier is not eligible for AER Assistance under
.
Commander’s Referral Program due to _________________________________________________________.
___ Soldier’s application is being returned to Unit Commander
___ Soldier’s request is being processed as a routine AER case per Unit Commander
.
11c. Name of AERO
Signature
11d. Date
For use of this form, see AERO Section Reference Manual or
AER FORM 600
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Aer Form 600 - Commander's Referral Program - Application For Army Emergency Relief (aer) Financial Assistance
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Aer Form 600 - Commander's Referral Program Application For Army Emergency Relief (aer) Financial Assistance
Business
