Assistance Request for Service Members
OFR assists wounded, injured and critically ill Service Members and Disabled Veterans from all branches.

If you are a wounded Service Member/Disabled Veteran, Family Member or Case Worker contacting OFR for assistance please fill out the “Assistance Request Form” below by clicking on the blue button. You can download the form and mail or fax it to us if you prefer.

Due to high volume of cases and limited funds all applications will be reviewed and determination of assistance depending on available funds at the time of the request will be made.


Phone: 888-289-0280
Fax: 888-505-2795
Email Us: Click Here

Service Members and Family Support Group
(Email us to join the PTSD group)

Assistance Request Form

Service Member Information

Have you received assistance from Operation First Response in the past?
Have you spoken to an Operation First Response Representative concerning this application?
If yes, please select the Representative:
  • - select a representative -
  • Peggy Baker
  • Sarah Baker
  • Crystal Howard
  • Nick Constantino
  • Representative Not Listed

Personal Information

  • State
  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virgina
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
Social Security Number
Number of Children
Marital Status
Service Member/ Veteran Date of Birth



Case Worker or Unit Contact Information

By submitting this application you are giving the Operation First Response Staff permission to contact your Case Worker to verify your situation.

Name of Case Worker or Unit Contact
Phone Number of Case Worker or Unit Contact
Email Address of Case Worker or Unit Contact

Military Information

Unit Deployed With
Date of Deployment


Military Branch
  • - select a branch -
  • Army
  • Army Reserve
  • Army National Guard
  • Marine Corps
  • Marine Corps Reserve
  • Navy
  • Navy Reserve
  • Air Force
  • Air Force Reserve
  • Air National Guard
  • Coast Guard
  • Coast Guard Reserve
Military Rank
  • - select a rank -
  • PVT
  • PV2
  • PFC
  • SPC
  • LCPL
  • CPL
  • SGT
  • SSG
  • GySgt
  • SFC
  • MSG
  • 1SG
  • MGySgt
  • SGM
  • CSM
  • WO1
  • CW2
  • CW3
  • CW4
  • CW5
  • 2LT
  • 1LT
  • CPT
  • MAJ
  • LTC
  • COL
  • SR
  • SA
  • SN
  • PO3
  • PO2
  • PO1
  • CPO
  • CPO1
  • CPO2
  • CPO3
  • SCPO
  • MCPO
  • CWO1
  • CWO2
  • CWO3
  • CWO4
  • CWO5
  • ENS
  • LTJG
  • LT
  • LCDR
  • CDR
  • AB
  • AMN
  • A1C
  • SrA
  • SSgt
  • TSgt
  • SMSgt
Currently Active Duty
If No, Disability rating %
Did you receive a Purple Heart?
Discharge Date Year
Description of Injuries or Illness

Assistance Information

Type of Assistance Required
Amount of Funds or Assistance Needed
Other Agencies or Foundations that have been Notified and/or Assistance Received From
Reasons for Assistance Request
Are you in need of finding employment? If so, would you like to be referred to an agency that can help with this need?

Electronic Signature

I Agree (Electronic Signature)

On my behalf and in behalf of my dependents, I fully and forever release, discharge, and hold harmless Operation First Response, Inc., and it’s directors, officers, employees and advisors of and from any and all claims, demands, actions, causes of action, suits, controversies and liabilities of every kind and nature accruing to me or my dependants arising directly and indirectly from, or on account of the activities and assistance of Operation First Response, Inc.

Please monitor your email for any important messages pertaining to your request. If assistance is approved you will be notified via email to submit the required supporting documents:

  • OFR Information Release Form (All Applicants)
  • DD-214 (if retired) (Must have an Honorable Discharge)
  • VA Award Letter (if retired)
  • VA or Picture ID
  • LES (if still in active duty)
  • Proof of Injury (if still active duty)
  • OFR pays the vendors directly whenever possible so copies of any bills that are part of the service request must be faxed or emailed to our office.

When all of the requested items are sent to us we will respond as quickly as possible. If you have difficulty faxing the requested items and have a scanner you can scan and email the supporting documents. Please monitor your email for any important messages pertaining to your request.