Request for Immediate Funding

This form is designed for submission and approval by DEBOTG after expenses are incurred. This form should be used by military members, veterans, or family support staff to request financial support for immediate emergencies. Verbal communication with any member(s) of the Board of Directors or their representatives shall not substitute for submission of this form.

Name of Requestor * First Last
Is Requestor a Delaware *
Military Member Veteran Family Support
Unit of Military Member *
What other agencies have been contacted for assistance?
Total Amount Requested *
Description of immediate financial hardship need *

Please describe in detail the circumstances of the immediate financial need. Provide the exact OR estimated expenses that the funds will be used to support. (If necessary, include additional paperwork.) If the recipient is NOT the same as the requestor, please give name.
Documentation that will be provided *

Include bills as necessary. Note that documentation must clearly support the expenses indicated above. An itemized receipt is requested. Provide the mailing address(s) to send payment of the requested bill(s) if approved.
Phone Number of Requestor * ### - ### - ####
E-mail of Requestor
Date Funds Needed By * MM / DD / YYYY
Do Not Fill This Out