ࡱ> 241 bjbj[[ 8"99 228$.$DyyyXyyyy@<*Ky0yx!xyxyyx2 R: Financial Aid Application Florida National Guard Foundation (Complete and forward this form with attachments to mailing address: Florida National Guard Foundation, P.O. 717 St. Augustine, FL 32085-0717 __________________________________________________________________________________________ Applicant Information: Name:_________________________________________ Email:____________________________________ Mailing Address:______________________________ City/State/Zip_________________________________ Home Phone:___________________ Work Phone:___________________ Cell Phone:__________________ Household Demographics: Adults_____ Children_____ Special Needs:_______________________________ Relationship (If not Military Member):__________________________________________________________ Military Member Name (If different than Applicant):_______________________________________________ Military Member Unit of Assignment:___________________________________________________________ __________________________________________________________________________________________ Services/Support Requested: $__________Food $__________Vehicle $__________Other (Specify) $__________Housing $__________Medical/Dental Care $__________Child Care $__________Prescriptions $__________Utilities $__________Insurance Total Requested: $____________ __________________________________________________________________________________________ Supporting Documents (Attached with Application): _____DD Form 214 _____Military/Dependent ID _____Deployment Order _____Other (Specify) _____Brief narrative of situation, events, reason or circumstances that led to this need. Include action plan to overcome current financial situation. __________________________________________________________________________________________ Requester Signature/Certification: My signature below certifies that the information I have provided is true and correct to the best of my knowledge. Applicant Signature_________________________________________________ Date____________________ __________________________________________________________________________________________ Unit Review: (Unit Commander/Authorized Representative) Name:__________________________________________ Rank:__________ Phone:____________________ Email:______________________________________________ Duty Position:__________________________ Reviewer Signature:______________________________________________ Date______________________ __________________________________________________________________________________________ DMA Staff: Received By_________________________ Date & Time_______________________ File#_______________     ;<' 0 < = > ? D ^ h m o t u z | ɾzzsnnfb^b^hOghRhW``hOg5 hR5 hRhR h05 hOg5 h,f$hOgh$h,zhOg5h,zhW``5h,zh$5 h>,5>*h>,CJaJh jCJaJhOgh>,CJaJhOgh15CJaJhz5CJaJhOghW``5CJaJhl5CJ aJ h}h}5CJ aJ $<' > ? Z [ ! ? [ \ gd,f$gd$gd>,$a$gd>,$a$gdW``   : < T Y Z [ t ! ? 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