The Good Ole Boys

APPLICATION FOR ARMY EMERGENCY RELIEF
(AER) FINANCIAL ASSISTANCE

1. Soldier's Name (Last, first, MI)

2. Unit

7. Home or Permanent Mailing Address of Soldier, Retiree, Dependent or Surviving Family
Member; Phone and Email Address

6. Rank

5. Branch

3. ETS/RET Date 4. SSN or AER Client ID #

Regular Army

Retired

Dependent

USAR

AR NG

Survivor

9. Special Power of Attorney

8. Applicant’s name and relationship (If other than Soldier or Retiree)

Yes

No

10. Reason (Provide a brief summary of the circumstances causing your emergency financial need. If more space is needed, continue
on separate sheet):

11. List the specific item(s) that are required to meet the emergency financial need:
$

Total

$

0.00

12. Applicant’s Certification
I hereby authorize the Department of the Army to supply any requested information contained in my official Army personnel and pay
files in connection with this assistance. I further authorize the Department of the Army, or any agency, to supply my latest home address, and/or official military address to AER whenever requested.
I further understand that AER is an independent private entity, not part of the U.S. Government. This application form, therefore, is not
subject to the Privacy Act (5 U.S.C. 552a). Information provided on this application, in some cases, will be provided by AER to the Army
in order to determine eligibility for and administration of financial assistance. I certify the information provided on this application is complete, true and correct.
12b. Date

12a. Signature of Applicant

13. Unit Commander or First Sergeant Review of Active Duty Applicant (Required for all Soldiers not eligible for Direct Access)
13a. I have reviewed Soldier’s request for AER assistance and recommend:

Approval

Disapproval

Indicate reason for approval or disapproval recommendation:

13b. Soldier

Is

or

Is not Pending Elimination From The Army.

13c....