APPLICATION FOR ARMY EMERGENCY RELIEF
(AER) FINANCIAL ASSISTANCE
1. Soldier's Name
3. ETS/RET Date 4. SSN or AER Client ID #
(Last, first, MI)
Home or Permanent Mailing Address of Soldier, Retiree, Dependent or
Surviving Family Member; Phone and Email Address
8. Applicant’s name and relationship
9. Special Power of Attorney
(If other than Soldier or Retiree)
(Provide a brief summary of the circumstances causing your emergency financial need. If more space is needed, continue
on separate sheet):
11. List the specific item(s) that are required to meet the emergency financial need:
12. Applicant’s Certification
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 further authorize the Department of the Army, or any agency, to supply my latest home ad-
dress, 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 com-
plete, true and correct.
12a. Signature of Applicant
13. Unit Commander or First Sergeant Review of Active Duty Applicant (Required for all Soldiers not eligible for Direct Access)
13a. I have reviewed Soldier’s request for AER assistance and recommend:
Indicate reason for approval or disapproval recommendation:
Is not Pending Elimination From The Army.
Name/Rank of Company Commander or First Sergeant, Signature, Phone #, and Email
14. Action by AER Officer
14a. Request is:
Loan Amount $
Grant Amount $
Disapproved. Soldier and Commander have been informed of the reasons for disapproval.
Forwarded to the Level II and/or III Approving Official for action.
14b. Name of AER Officer and Signature
AER FORM 700, dated 9 May 2 0 16
(Local Reproduction Authorized)
Previous editions of this form are obsolete