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001 // the first step

join the family

This is the first step of a multi-step application process. Once this form is reviewed and the basic-level criteria are met, you may be invited to continue to the next step where you will be asked to submit a more comprehensive application. From this initial form through the entire process, you are being screened for suitability to receive such a substantial gift. Your accuracy, thoroughness, and timeliness in completing this will be examined closely.

1. Are you applying as a veteran or first responder?

2. Are you the service member's surviving spouse?

3. Are you applying for a new home or modification to your existing home?

This form may also be downloaded and emailed to contact@OperationFinallyHome.org.

Contact Information

Your Full Legal Name

Full Legal Name of Service Member

Full Legal Name of First Responder

Address

City

State

Zip

Home Phone

Cell Phone

Email

Service History

What was youryour spouse's service area (Police, Firefighter, EMT, etc.) and dates of service?

What is your service status (active service, retired, medically retired)?

Date and circumstances of your retirement or medical retirement?

Has your service-related injury or illness required you to obtain Social Security Disability pay?

Please provide contact information for your commanding officer or a member of your chain of command at the time of your injury or illness. This is a requirement. We cannot proceed with our review without this information.

Date of first responders passing.

Was the first responder’s death due to a wound or injury sustained while in the line of duty?

Did you receive any life insurance benefits as a result of your spouse’s passing?

Please provide contact information for your spouse’s commanding officer or a member of their chain of command at the time of your injury or illness. This is a requirement. We cannot proceed with our review without this information.

Military History

Did youyour spouse serve in the military?

What was youryour spouse's branch, dates of service, and rank?

What is your military status (active duty, retired, medically retired, discharged, or separated) and if on active duty, what is your expected separation date?

What type of discharge did you receive?

Date and circumstances of your retirement, medical retirement, discharge, or separation?

Date of service member’s passing.

Was the services member’s death due to a wound or injury sustained in combat or training for combat?

Please provide youryour spouse's military job and list of deployments.

Please list all combat and/or training for combat injuries.

Please provide a complete breakdown of your DoD combat and/or training for combat disabilities with their ratings.

Please provide a complete breakdown of your VA combat and/or training for combat disabilities with their individual ratings.

Did you receive your spouse’s SGLI and/or TSGLI? If so, what was the amount?

Are you receiving Social Security related to the veteran’s death? If yes, what is the amount?

Did you serve in the military?

Please provide contact information for your commanding officer or a member of your chain of command at the time of your injury or illness. If this is not possible, you must provide the last three enlisted or officer evaluations for that same time period. While this may be difficult, we will not proceed with your application without this information. Military personnel records can be found on eBenefits (www.ebenefits.va.gov).

Please provide contact information for your spouse’s commanding officer or a member of their chain of command prior to their injury or illness. This is a requirement. While this may be difficult to locate, we cannot proceed with our review without this information. You may want to contact Casualty Assistance to help answer this question.

General Information

What is your current living situation?

Do you own a home, or do you currently have a mortgage?

In what city and state would you like to live and why?

Are you currently in or have you filed for bankruptcy and if yes, what is the current status.

Are there any liens on your home?

Have you ever been arrested, charged, convicted, or currently facing conviction of a Class A or Class B misdemeanor and/or felony? If yes, what were/are the circumstances and the final outcome?

Do you have any dependents? If yes, what are their names, ages, gender, and relationship to you?

Who lives with you in your home now?

If chosen, who will be living in the home with you?

Does anyone else live with you? If yes, what are their names, ages, gender, and relationship to you?

Are you currently married? Do we have permission to speak to your spouse?

Have you remarried?

List the source and amount of income received by each adult permanently living in the home.

List other nonprofits/organizations that have provided you with assistance.

Why do you need assistance from Operation Finally Home?

Referral Source?

Are you employed?

Spouse's Contact Information

Name

Address

City

State

Zip

Home Phone

Cell Phone

Email

Home Status

Tell us about the repairs that need to be made to your home and how these repairs will meet your needs (mobility, safety, security, etc.)

Terms

I understand that if I am selected, I am required to live in the home for a minimum of seven (7) years as outlined in the Terms of Homeownership. Initials:

Supporting Documents

In addition to filling out the form, please provide the following documents (if issued).

If youyour spouse also served in the military, in addition to filling out the form please provide the following documents (if issued).

"Member 4" Copy of DD Form 214 that shows character of discharge.

Copy of DoD-MEB/PEB official rating.

Copy of most recent VA official rating listing complete breakdown of ratings. Ratings must come from VA letter within the past two years on current eBenefits copy.

DD Form 1300 Report of Casualty if one was issued.

Service Member’s civilian certified Death Certificate if one was issued.

Signature

I certify that all information contained in this application is true and accurate to the best of my knowledge. If I have willfully provided any false or misleading information, I understand that my consideration for this program be forfeited at the sole discretion of Operation Finally Home. In addition, in the event that I am publicly accused of an act of moral turpitude (substantiated by the preponderance of evidence, a court decision, or on my own admission), a violation of any Federal law or any other conduct which subjects or could be reasonably anticipated to subject Operation Finally Home and/or its supporters to public ridicule, contempt, scorn, hatred or censure, or could materially diminish the potential successful completion of the gift of a mortgage free home if I am chosen, Operation Finally Home will have the right to remove me from consideration at any time during the process. I also certify that I have read, understood and agree to the Terms of Homeownership as outlined by Operation Finally Home.

Signature of Applicant

Signature of Spouse

Note: The completion of this document in no way commits Operation Finally Home to construct a home for the applicant listed above. This information will be used by Operation Finally Home as a part of its interview process to determine the steps that will be taken, if any in their consideration of support of the above-mentioned applicant as a part of its program.