Back to Home Beneficiary Form First Name* Last Name* Email* Phone Number* Street Address* City* Province* Postal Code* Which support service do you need assistance with? Phone Request Request a phone for communication purposes Calling Card Request Request calling cards for communication Helping Hero Request Request assistance from our helping heroes Please select a service type Additional Information Date of Birth Social Security Number (Last 4 digits) Program ID ℹ️ Enter any known approved county, state, or federal programs you are currently receiving support (SNAP, VA Benefits Programs, etc.) Reference Charity Box Select a charity (optional) Red Cross Salvation Army United Way Veterans Affairs Local Community Center Other ℹ️ Enter any charities that recommended you to submit for the Cell Phones For Soldiers Veteran Mobile Program (Ex: Purple Heart Foundation) Sponsor Type ℹ️ Enter any official community or government organization Point of Contact Information that can justify your requirement (VSO, VA Officers, Church Officials, Other Charity Organizations, etc.). Years Served and Branch* Self Declared Income* Any Low Income Programs? (optional) Upload file (DD214)* 📎 Upload File Allowed types: PDF, JPG, PNG, GIF, Max size: 5MB Type of Discharge* Explanation if not Honorable (optional) Notes: All Veterans who submit a Cell Phones For Soldier (CPFS) veteran application for the Mobile Program automatically grants approval for CPFS and partners to search for available statewide and federal lifeline programs (California LifeLine, etc.) across the country that can potentially satisfy this requirement. If the veteran qualifies for a state or federal lifeline program, CPFS will work with the program to provide the veteran with a Cell Phones with 12-month services through the state program. If a veteran doesn't qualify for a state or federal lifeline program, Cell Phones For Soldiers will review the application for the CPFS Mobile Program. State and Federal lifeline program decisions have no impact on receiving approval from the Cell Phones For Soldiers Veteran Mobile Program. Submit Number of Phone Cards Requested* Address Type* APO – Army Post Office FPO – Fleet Post Office DPO – Diplomatic Post Office Submit Total Cost / Funding Request Description / Any thing we should know Submit OK Make a Difference TodayYour donation can make a lasting impact on the lives of military members and veteransDonate Now
