Accommodation Assistance Application
To qualify, the veteran must reside in Michigan and the need for accommodation must be service related. Once your application is received, it will be reviewed within 3 business days to determine if the necessary requirements are met.
Application Type
*
Please Select
Self-Veteran
Nominator
Nominator Name
*
First Name
Last Name
Nominator Phone Number
*
Please enter a valid phone number.
Nominator Email
*
example@example.com
Veteran Name
*
First Name
Last Name
Branch of Service
*
Please Select
Air Force
Army
Coast Guard
National Guard
Navy
Marine Corps
Veteran Phone Number
*
Please enter a valid phone number.
Veteran Email
*
example@example.com
Veteran DOB
*
/
Month
/
Day
Year
Date
Veteran Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
County
*
Please Select
Allegan
Barry
Eaton
Kent
Mecosta
Montcalm
Muskegon
Newaygo
Oceana
Ottawa
OTHER
Has the Veteran received assistance from other Non-Profit Organizations in the past 12 months?
*
Yes
No
What was the organization and what was the circumstance?
*
Does the Veteran have a VA Disability Rating?
*
Yes
No
What is the rating?
*
Please Select
0%-30%
40%-70%
80%-90%
100%
Were the injuries sustained in combat?
*
Yes
No
Amount of financial support the Veteran needs
*
Example: $250.00
Please describe in detail, the assistance needed:
*
Attach DD-214 or VA Disability Certification Letter (Required) and any other supporting documentation
*
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