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LETTERMEN OF THE USA
VETERAN ASSISTANCE APPLICATION
Please complete all applicable fields. Information will be reviewed confidentially.

First name*

Last name*

Phone*

Email*

Address*

Branch of Service*

Rank*

Combat deployment*

If yes, specify war era

Entry date (MM/DD/YYYY)*

Exit date (MM/DD/YYYY)*

Type of Discharge*

If other than Honorable, please explain

PROGRAM REQUEST

Type of program applying for*

In as much detail as possible, describe your needs and how Lettermen of the USA can assist.*

Upload DD214*

Submitting this form does not guarantee assistance. Eligibility and available resources may vary.

Signature*

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Checks payable to "Lettermen of the USA"

459 Main Street, Suite 101 PMB 226

Trussville, AL 35173

LotUSA is a 501(c)(3) charitable organization. EIN – 82-3593860

© 2026 by Lettermen of the USA

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