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Apply for Home Modification

About Us
- Videos
How to apply
- Home Modification
- Vehicle Modification
Projects
Events
Volunteer
Sponsors
Contact

Application Form

Building Dreams for Marines steps in to provide no-cost planning, designing and building services!

Building Dreams for Marines has been established to assist Marines who have honorably served and have a physically-limiting condition, with life-enhancing modifications to their homes. For our brave men and women who have lost some aspect of their mobility, Building Dreams for Marines steps in to provide no-cost planning, designing and building services.

Eligibility Requirements:
Any Marine who has served honorably and who has a physically-limiting condition may apply. We are currently accepting applications from NH-based Marines.

"*" indicates required fields

First Name*

Last Name*

Address

Addres 2

State/Province

City/Town

Zip Code

Email*

Dates of Service*

Gender

Male

Female

Do you have a DD214?

Yes

Discharge

Honorable

Other

Have you applied for VA Benefits?

Yes

VA Rating*

Home receiving updates owned by the Veteran

Yes

Can you provide proof of home owners insurance?

Yes

Not including disability compensation, have you applied for and/or received any other financial assistance from the VA?

Yes

What financial assistance you received?*

Have you, or are you currently receiving financial assistance from any other organization?

Yes

What financial assistance you received?*

How did you hear about Building Dreams For Marines?

Website

Word of mouth

Other

Next of Kin's Information

First Name*

Last Name*

Email*

Phone*

Location of Needs

Type of Work Needed

Please use this area for any additional information that may help Building Dreams For Marines better accommodate your needs

Attention to Orders: In order for this application to be considered, a copy of the Veteran's DD214 (Member 4 Copy) and or equivalent discharge paper work if DD214 was never issued must accompany this application. If discharge documents are not provided this will result the application to be disqualified.

Disclaimer: On my own behalf and the behalf of my dependents, I fully and forever release, discharge and hold harmless Building Dreams for Marines and its Directors, Officers and Advisors of and from any and all claims, demands, actions, suits, controversies and liabilities of any kind and nature accruing to me arising directly or indirectly from or on account of the activities and assistance of building Dreams for Marines. I further authorize the use and release and dissemination of my medical information and/or records for use by Building Dreams for Marines.

Veteran's Information

First Name

Last Name

Gender

Address

Years of Service

War/Conflict Service

Present Picture

Service Picture

Injury(s) which modifications addressed

Additional Options

If the option was presented, I would allow a public relations event to be held at the home of which the modifications had been done

If the invitation was presented, I, the Veteran would like to accompany Building Dreams For Marines at a public event in the future.

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Phone

This field is for validation purposes and should be left unchanged.

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Contact Info

Building Dreams For Marines
P.O. Box 1704
Nashua, NH 03061

Tax ID: 27-4966984