AZFHMR Assistance Request Form

The Arizona Fallen Hero Memorial Riders provide direct assistance for basic living needs to families of fallen first responders and military service members, as well as active duty and retired first responders and veterans experiencing financial hardship due to crisis, loss, or life-altering events. Assistance is intended to help individuals and families who are unable to meet essential living expenses such as housing, utilities, food, transportation, or medical needs. 





Additional Information and Explanation


If you are submitting this request on behalf of someone else, please provide your information and your relationship to the individual in need.

Eligibility

Military Assistance Policy

Veteran Assistance Eligibility: Arizona Fallen Hero Memorial Riders currently provides financial assistance to veterans who received an Honorable or General (Under Honorable Conditions) discharge. Applicants with a Dishonorable discharge are not eligible for assistance. Other discharge classifications may be reviewed on a case-by-case basis if permitted by AZFHMR policy.

Please select your discharge status. This information is used to determine eligibility for assistance.


Tell Us About Your Request


What Best Describes the Primary Circumstance That Led to Your Request for Assistance?

(Select the one option that best describes your primary circumstance.)

What Type of Assistance Are You Primarily Requesting?

(Select the one option that best describes your primary circumstance.)


Supporting Documents

Example of supporting documents:  Utility bill or shutoff notice, rent or mortgage statement, medical bill or treatment-related expense, proof of income loss (recent pay stub, employer note, or leave documentation), repair estimate (for vehicle or emergency repairs), referral from an agency, supervisor, or organization (if applicable).


I certify the information provided on this application is true and accurate to the best of my knowledge. I understand Arizona Fallen Hero Memorial Riders may request documentation, including my DD Form 214 or other proof of military service and discharge status, to verify eligibility.

I certify that the information provided is true and accurate to the best of my knowledge and that I am requesting assistance due to financial hardship. I understand that providing false or misleading information may result in denial or revocation of assistance.

I understand that assistance is provided in a structured and accountable manner, and that payments may be made directly to landlords, utility providers, or service vendors to ensure funds are applied to essential needs.

I understand Arizona Fallen Hero Memorial Riders provides emergency, short-term assistance intended to help individuals and families through temporary hardships. Approval of this request does not guarantee future assistance. Any additional requests will be evaluated on a case-by-case basis based on eligibility, demonstrated need, available funding, and the applicant's efforts toward resolving the hardship.

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