Form Name:

Acceptable Expenditures List

Investigator Name:

Carly Wilder

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VSO/Eligibilty Specialist*
Please select the VSO/Eligibilty Specialist that you're submitting this form to.
If you are in need of Financial Assistance for more than this first visit and you receive income from any source prior to your next VSC visit, you must bring proof of that income and how it was used towards your household on each and every visit for assistance thereafter. If you are not able to account for the income you have had by receipt (or bank activity) and show that it has been used on the below list of acceptable expenditures only (and only for the Veteran and legal dependents), no financial assistance will be granted.
Veteran / Applicant Digital Signature*
I understand the restrictions of the CCVSC assistance, and if assistance is granted will comply with these requirements.
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