Here is the link to download the application: DOWNLOAD
The following information is asked on the application and is provided below for those viewing this website on a mobile device or who cannot download the formatted application.
Criteria
The Peter Wojtecki Veteran Housing selection committee will assess multiple
criteria, including residency, military service, criminal records. Veteran must be drug free.
Eligibility
Must be veteran of the U.S. Armed Forces
Must have honorable discharge from military
Must demonstrate that the hardship is due to no fault of his own
Does not receive assistance from another agency.
Section A:
Name:
Social Security Number:
Street Address:
City, State, Zip:
Phone Number:
E-mail Address:
Date of Birth:
Section B: .
Proof of Military Service Proof of Residency
Discharge Papers/DD-214. Driver’s License
For service members, copy of current Military I.D. Card.
Copy of Bills for which Assistance is Requested
Must include account’s name as well as creditor’s name and address
For assistance with repairs, two different written estimates on company letterhead are required.
Last year’s Income Tax Return
Past three months of statements
Served during: Circle wars that apply
World War II Korea Vietnam Desert Storm Bosnia/Kosovo Afghanistan Iraq
Section C
Request Assistance with: Please describe the expenses you need assistance with.
Section D
Reason for Financial Hardship: Please describe why you are unable to meet this need on your own.
Attach additional documents as necessary.
Section E
What you have done to resolve the hardship: Attach additional documents as necessary.
Section F
Other Agencies you are working with to resolve your hardship: Red Cross, Salvation Army, Local Church, Food Bank, etc.
Recipient Related Eligibility:
Recipient must remain in good standing in his/her community. The recipient must be both a spokesperson and a representative of the Peter Wojtecki Veteran Grant and his/her conduct is of paramount importance to the Committee. In the event the recipient loses his/her good standing, as determined solely by the Veteran Assistance Committee, all award payments will permanently cease. There is no provision for reinstatement of the award. If a recipient loses his/her good standing and does not notify the committee of this information on a timely basis, any award pay-ment made by the Trust, as a result of the delay in notification by the recipient, is required to be repaid.
Terms and Conditions:
Please initial all signatory blocks below. This form is essential to the review and approval process. We want to emphasize that each application will be reviewed independently and each case will stand on its own merit.
I understand that, if necessary, I will provide information to substantiate my request, in-cluding governmental records, expense/income information and medical information . This information may be shared with other agencies to assist in processing my application for assistance. This will be kept confidential. I understand that if the request cannot be substantiated, it will not be possible to consider or approve my application.
I agree to obey all the policies of the program and comply with any reasonable directions with respect to questions or concerns that may arise. In addition, I authorize the Peter Wojtecki Veteran Grant to request any information from medical labs and credit reporting agencies.
I understand that I may be required to be interviewed before the grant is awarded but this does not guarantee that I will receive the grant.
I understand that the Peter Wojtecki Veteran Fund Committee may request to use my name and the particulars of the grant for promotional reasons. There is no promise of compensation for my participation. If I choose to maintain case confidentiality it will in no way influence my application.
___________________________________
Applicant’s Signature
___________________________________
Date
Check List:
Proof of Military Service
Proof of Residency
Copy of Bills for which Assistance is Requested
Past three months of financial statements
Copy of Income Tax Return
Contact Information & Address
Peter Wojtecki Veteran Grant
P.O. Box 404
New Canaan, CT 06840
203-359-0169
