Financial Assistance

Below are the forms required for the Delaware County Veteran Service Office Financial Assistance program.  At a minimum, the Financial Assistance Application and Financial Assistance Consent form must be completed.  If the applicant is receiving gift cards, the Gift Card Agreement form must be completed as well.  Also below is a document describing the program.

Financial Policy

Quarterly Meijer Gift Card Agreement

Quarterly Meijer Gift Card FA worksheet

F-A Cover Sheet

F-A initial application

F-A Addendum form subsequent requests

FA Monthly Calculator




Dental – A program that is a part of the Financial Assistance Program


The Delaware County Veteran Service Office, working with local dentist, will provide preventative and emergency dental care to the veteran only currently.  Additional considerations outside of preventative or emergency care or for someone other than strictly the veteran will be run through the “regular” Delaware County Financial Assistance program (above).  The Dental Application will need to be completed (below).  The Veteran must be honorably discharged and be a resident of Delaware County for at least 90 days.  Additionally:


-Annual income at or below 250% of the federal poverty level.


An applicant CANNOT go directly to the Dentist without first verifying veteran status and income eligibility by the Delaware County Veteran Service Office.