CTMD Form 7-1 "Military Relief Fund Application" - Connecticut

What Is CTMD Form 7-1?

This is a legal form that was released by the Connecticut Military Department - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on January 1, 2017;
  • The latest edition provided by the Connecticut Military Department;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of CTMD Form 7-1 by clicking the link below or browse more documents and templates provided by the Connecticut Military Department.

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Download CTMD Form 7-1 "Military Relief Fund Application" - Connecticut

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CTMD Form 7-1
(Rev. 1/2017)
CONNECTICUT MILITARY DEPARTMENT
INSTRUCTIONS FOR
MILITARY RELIEF FUND APPLICATION
PURPOSE: The Military Relief Fund was established for the purpose of making grants to service members and their
immediate family members for essential personal or household goods or services if the payment for such goods or services
would be a hardship due to military service.
ELIGIBILITY: In order to be eligible for assistance under the Military Relief Fund, the following criteria must be met:
1. Eligible Service Member: The service member must be actively serving the armed forces of the United States on
active duty or as part of the National Guard or the Reserves.
2. Immediate Family Member: The applicant must be the service member or the spouse, child, or parent of the eligible
service member. Other family members may be eligible if they reside in the same home as the eligible service
member.
3. Domicile in the State of Connecticut: The applicant and the service member must be currently residing in the State
of Connecticut. (Service members currently on active duty and living outside the State of Connecticut are eligible
if they claim Connecticut as their state of legal residence).
4. Hardship: There must be a financial hardship encountered by the service member or the immediate family member.
Such hardships include, but are not limited to:
Loss of income or increase in expenses due to deployment of the eligible service member
Pay & allowances from eligible service member is late or insufficient to cover necessary household
expenses
Injury to the applicant has resulted in a significant loss of income
House fire or condemnation renders the applicant in immediate need for assistance
Injury to a family member, such as a motor vehicle accident, causes a loss of income or increase in
expenses.
5. Connection to Military Service: The financial hardship must have been caused, in whole or in part, by the eligible
service member’s military service obligation.
LIMITATIONS:
Funds will not be approved to pay for alimony, child support, gambling debts, legal expenses arising from
criminal offenses, bad check fees, purchase real estate, purchase bonds, securities, mutual funds, other
investments, or make payments determined outside the scope of the program.
Long-term indebtedness caused by poor financial planning, ill-advised expenditures or extended unemployment
do not qualify as a valid hardship for this program.
DOCUMENTATION:
1. Completed and signed application form (CTMD Form 7-1)
2. Verification of service member’s military status
3. Relationship to eligible service member (Marriage Certificate, Birth Certificate, etc)
4. Proof of Connecticut residency for the applicant and service member
5. Proof of Hardship – wage stubs, bank accounts, lease, mortgage statement, property taxes, medical bills, other
necessary expenses.
PROCESSING STANDARDS: All applications will be reviewed within seven (7) days of receipt of the CTMD Form 7-1 by
the Connecticut Military Department. Grants are approved by a six (6) person board. A majority of board members must
approve the grant. The maximum grant amount is $5,000.00.
SEND APPLICATIONS & SUPPORTING DOCUMENTATION TO:
Connecticut Military Department
Military Relief Fund
360 Broad Street Room #113
Hartford, Connecticut, 06105-3706
(860) 493-2721 (fax)
Page 1 of 6
CTMD Form 7-1
(Rev. 1/2017)
CONNECTICUT MILITARY DEPARTMENT
INSTRUCTIONS FOR
MILITARY RELIEF FUND APPLICATION
PURPOSE: The Military Relief Fund was established for the purpose of making grants to service members and their
immediate family members for essential personal or household goods or services if the payment for such goods or services
would be a hardship due to military service.
ELIGIBILITY: In order to be eligible for assistance under the Military Relief Fund, the following criteria must be met:
1. Eligible Service Member: The service member must be actively serving the armed forces of the United States on
active duty or as part of the National Guard or the Reserves.
2. Immediate Family Member: The applicant must be the service member or the spouse, child, or parent of the eligible
service member. Other family members may be eligible if they reside in the same home as the eligible service
member.
3. Domicile in the State of Connecticut: The applicant and the service member must be currently residing in the State
of Connecticut. (Service members currently on active duty and living outside the State of Connecticut are eligible
if they claim Connecticut as their state of legal residence).
4. Hardship: There must be a financial hardship encountered by the service member or the immediate family member.
Such hardships include, but are not limited to:
Loss of income or increase in expenses due to deployment of the eligible service member
Pay & allowances from eligible service member is late or insufficient to cover necessary household
expenses
Injury to the applicant has resulted in a significant loss of income
House fire or condemnation renders the applicant in immediate need for assistance
Injury to a family member, such as a motor vehicle accident, causes a loss of income or increase in
expenses.
5. Connection to Military Service: The financial hardship must have been caused, in whole or in part, by the eligible
service member’s military service obligation.
LIMITATIONS:
Funds will not be approved to pay for alimony, child support, gambling debts, legal expenses arising from
criminal offenses, bad check fees, purchase real estate, purchase bonds, securities, mutual funds, other
investments, or make payments determined outside the scope of the program.
Long-term indebtedness caused by poor financial planning, ill-advised expenditures or extended unemployment
do not qualify as a valid hardship for this program.
DOCUMENTATION:
1. Completed and signed application form (CTMD Form 7-1)
2. Verification of service member’s military status
3. Relationship to eligible service member (Marriage Certificate, Birth Certificate, etc)
4. Proof of Connecticut residency for the applicant and service member
5. Proof of Hardship – wage stubs, bank accounts, lease, mortgage statement, property taxes, medical bills, other
necessary expenses.
PROCESSING STANDARDS: All applications will be reviewed within seven (7) days of receipt of the CTMD Form 7-1 by
the Connecticut Military Department. Grants are approved by a six (6) person board. A majority of board members must
approve the grant. The maximum grant amount is $5,000.00.
SEND APPLICATIONS & SUPPORTING DOCUMENTATION TO:
Connecticut Military Department
Military Relief Fund
360 Broad Street Room #113
Hartford, Connecticut, 06105-3706
(860) 493-2721 (fax)
Page 1 of 6
CTMD Form 7-1
(Rev. 1/2017)
CONNECTICUT MILITARY DEPARTMENT
MILITARY RELIEF FUND APPLICATION
APPLICANT INFORMATION
Last Name
First Name
Middle Initial
Mailing Address
City
State
Zip Code
Primary Phone Number
Secondary Phone Number
E-Mail
Social Security Number
Relationship to Service Member
Self
Child
Other
Spouse
Parent
____________________
SERVICE MEMBER INFORMATION
Last Name
First Name
Middle Initial
Connecticut Resident
Unit of Assignment
Location Currently Stationed
Yes
No
Rank
Branch of Service
Component
Social Security Number
Army
Air Force
Active Duty
Navy
Marines
National Guard
Years of Service
Coast Guard
Reserves
Primary Phone Number
Secondary Phone Number
E-Mail
OTHER HOUSEHOLD MEMBERS
(List all everyone who lives in the home with you)
Name
Date of Birth
Relationship
Page 2 of 6
CTMD Form 7-1
(Rev. 1/2017)
CONNECTICUT MILITARY DEPARTMENT
MILITARY RELIEF FUND APPLICATION
FINANCIAL INFORMATION
Applicant Income
Name of Employer
Hours per Week
Pay Rate
Other Income
(Second Job, Child Support, Alimony, Pension, etc.)
Other Household Member Income (Spouse, Parent, etc.)
Name of Employer
Hours per Week
Pay Rate
Other Income
(Second Job, Child Support, Alimony, Pension, etc.)
Available Assets
(List all checking, savings, CDs, investments and any other type of account you currently own)
Account Type
Current Balance
Expenses
Expense Type
Current Balance
Mortgage/Rent
Utilities
Loans (Auto, Student, etc.)
Insurance (Auto, Medical, Life, etc.)
Other
Page 3 of 6
CTMD Form 7-1
(Rev. 1/2017)
CONNECTICUT MILITARY DEPARTMENT
MILITARY RELIEF FUND APPLICATION
HARDSHIP
Please describe the hardships you are currently experiencing:
What do you need help with?
What is the financial burden to yourself and your family?
Provide a timeline of events if appropriate
(Attach copies of estimates, bills and any other relevant documentation)
Page 4 of 6
CTMD Form 7-1
(Rev. 1/2017)
CONNECTICUT MILITARY DEPARTMENT
MILITARY RELIEF FUND APPLICATION
MILITARY CONNECTION TO THE HARDSHIP
In order to be eligible for a grant from the Military Relief Fund, there must be a connection of the financial hardship to
the service member’s military service.
How did the military cause the current hardship?
For example:
Did the requirement to perform military service effect your overall income?
Are there added expenses due to military service?
Was the service member injured while in the performance of military duty?
Did the service member’s military obligation prevent them from being available to perform routine household
work or repairs?
Page 5 of 6