Financial Assistance Application

SALUTE, INC. Financial Assistance Application

  • Must have served in the US military, discharged in 2013 or later, and be 50% or more service connected.
  • Assistance could take 3-4 weeks. Cases are handled on a first come first serve basis.
  • Must include a valid & legible copy of your DD214.
  • Must include photo copy of state issued ID (driver’s license or state ID).
  • Must include VA documentation of injuries & disability rating.
  • A military Point-of-Contact including phone number and email address is required. This person should be a VA case worker or mental/physical health counselor who understands your history and current situation, and has your written consent to discuss your case.
  • Copies of bills for which you are requesting payment assistance. *W9 required for all rental payments.
  • Applications can be submitted in one of two ways:
    • Filling out this web form, OR by
    • Downloading, completing, and printing the PDF and submitting it to us in one of three ways:
      1. faxing to (847) 359-8818 (preferred),
      2. scan and emailing it to, or
      3. Mail to SALUTE, INC. / P.O. Box 2663 / Palatine, IL 60078

    Note: No cell phone or camera pictures of application or additional documents will be accepted.

  • The application must be complete. An incomplete application cannot be processed.

** Any altered or falsified documentation is considered a felony **

    Personal Information

    Veteran Applicant Information:

    Date of Birth:
    Are you employed?
    Marital Status:
    Is your spouse employed?
    Do you have dependent children under age 18? / How Many?

    Branch of Service:

    Dates of Active Duty (formatted YYYY-MM-DD):

    After your discharge, which of the following applies?
    Currently rated at (%):
    Do you require a caregiver?
    Have you ever received financial assistance from SALUTE, INC. or from any other organizations?

    Mandatory Point of Contact Information

    Military/VA Case Worker/Mental or Physical Health Counselor Point of Contact:

    The verification & release of all case information must be provided in order to process application.

    Financial Record

    Monthly Income

    Monthly Needs/Expenses

    Goals & Objectives

    What are you requesting help with?
    How will your situation be financially improved in 3-6 months assuming SALUTE, INC. gives you financial assistance?

    Are you a representative?

    Are you submitting this application on behalf of the Veteran Applicant?