Aer Form 700 - Application For Army Emergency Relief (Aer) Financial Assistance printable pdf download

APPLICATION FOR ARMY EMERGENCY RELIEF

(AER) FINANCIAL ASSISTANCE

1. Soldier's Name

2. Unit

3. ETS/RET Date 4 SSN or AER Client ID #

(Last, first, MI)

Applicant’s name and relationship

(If other than Soldier or Retired Soldier)

7. Sponsor's Email Address

6. Sponsor's Phone #

8. Home or Permanent Mailing Address of Sponsor

9. Are you currently in bankruptcy

or do you plan to file bankruptcy

within the next six months?

10. Branch

11. Member Type

12. Special Power of Attorney

Yes

Regular Army

ARNG

Active

Dependent

Yes

If Yes, what Chapter? ________

USAR

Retired

Survivor

_______________

13. Reason (Provide a brief summary of the circumstances causing your emergency financial need.)

14. List the specific item(s) that are required to meet the emergency financial need:

Total

15. 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 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.

15b. Date

15a. Signature of Applicant

16. Unit Commander or First Sergeant Review of Active Duty Applicant (Required for all Soldiers not eligible for Direct Access)

16a. I have reviewed Soldier’s request for AER assistance and recommend:

Approval

Disapproval

Indicate reason for approval or disapproval recommendation:

16c. Name/Rank of Company Commander or First Sergeant

16b. Soldier

is or

is not pending elimination from the Army.

16f. Date

16d. Company Commander or First Sergeant's Phone & Email

16e. Signature of Company Commander/First Sergeant

17. Action by AER Officer

17a. Request is:

Approved.

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.

17b. Name of AER Officer

17c. Signature of AER Officer

17d. Date

AER FORM 700, dated 6 July 2017

(Local Reproduction Authorized)

Previous editions of this form are obsolete

Aer Form 700 - Application For Army Emergency Relief (Aer) Financial Assistance

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