Aer Form 600 - Commander'S Referral Program Application For Army Emergency Relief (Aer) Financial Assistance Page 6

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STREET ADDRESS:
CITY:
STATE:
ZIP:
HOME TELEPHONE # (with area code):
WORK TELEPHONE # (with area code):
EXT:
OTHER TELEPHONE (example: cell):
EMAIL ADDRESS:
EDUCATION LEVEL:
 No HS
 2 yrs college
 Post Baccalaureate
 HS
 AA
 MA/MS
 Occupational Training
 3 yrs college
 Post Masters
 Less than 1 yr college
 4 yrs college
 DD
 1 yr college
 BA/BS
 PhD
This section MUST be completed even if you are the sponsor:
SPONSOR’S LAST NAME:
FIRST:
MI:
SPONSOR’S SSN: __________________ BIRTH DATE: _________ PAY GRADE:
 INITIAL TERM OF SERVICE?
(fill the circle if “Yes”)
SPONSOR’S STATUS:
 Gov’t Civilian
 Active
 Retired
 Reserve/National Guard
SPONSOR’S MILITARY UNIT:
TOTAL NUMBER OF HOUSEHOLD MEMBERS:
NAME OF FAMILY MEMBERS
AGE/RELATIONSHIP
DATE OF BIRTH
DATE MARRIED: _____________
The information you have provided will be used to establish your ACS Client
record. This is a one-time requirement.
---Thank You---
Your cooperation is appreciated.
REVISED ON: 22-Mar-12

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