Apply for Financial Assistance

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Send us your contact information and what you need through our secure Request Assistance form and a VAC team member will follow up. Please do not enter your Social Security number online — we collect that in person.

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Two ways to apply

Fill this out online below, then Print / Save it and bring, mail, or fax it to our office — or come in and we’ll complete it with you. Prefer paper? Download the printable PDF.

Eligibility. Macoupin County residents only; gross monthly household income at or below 130% of the Federal Poverty Guideline for household size. Total assistance is limited to $3,000 per household per VAC fiscal year (October 1 – September 30). Valid for one fiscal year; renew annually. (Policy MACVAC-VS-001; Resolution R-2026-16.)

Bring: DD-214/discharge, proof of Macoupin County residency, photo ID, the bill/invoice for what you are requesting, proof of income (last 30 days), 90-day bank statement, and marriage license/birth certificates if claiming dependents.

Section 1 — Applicant & Household

Veteran Name

Date

SSN

Date of Birth

Phone

Residence Address

Mailing Address (if different)

Spouse Name (if any)

Spouse SSN

People in household

Macoupin County resident? Yes No

How long at this address

Dependents in household (Name — Date of Birth — Relationship)

Section 2 — Monthly Household Income (net)

Source

Veteran

Spouse / Other

Employment (wages)

VA Compensation / Pension

Social Security (SS / SSI / SSDI)

Unemployment

Retirement / Other Pension

Child Support / Alimony

SNAP / TANF / Public Aid

Other

TOTAL MONTHLY INCOME

Section 3 — Monthly Household Expenses

Rent / Mortgage

Electric

Gas

Propane

Water

Sewer

Trash

Phone / Internet

Vehicle Payment (Vehicle 1)

Vehicle Payment (Vehicle 2)

Vehicle Insurance

Auto Fuel

Food / Groceries

Medical / Prescriptions

Childcare

Child Support Paid

Other

TOTAL MONTHLY EXPENSES

Section 4 — Debts & Obligations

Creditor / Account Type

Balance Owed

Min. Monthly Pmt

TOTAL MONTHLY DEBT PAYMENTS

Section 5 — Assets

Bank — Checking balance

Savings balance

Vehicle 1 (Make/Model/Year)

Owned Financed

Vehicle 2 (Make/Model/Year)

Owned Financed

Section 8 — Hardship Explanation

Explain the emergency, unexpected expense, or loss of income. Attach copies of bills, invoices, or receipts.

Section 9 — Certifications & Signature

I certify that the information in this application is true and complete to the best of my knowledge. I understand that providing false information may result in denial or termination of assistance and possible prosecution under Illinois law. I understand eligibility is based on household income at or below 130% of the Federal Poverty Guideline for my household size; that total assistance is limited to $3,000 per household per VAC fiscal year (October 1 – September 30); and that I may reapply 30 days from the date of assistance if my situation is unchanged.

Release of Information: I authorize banks, employers, agencies, and the Bureau of OASDI to release information about my income, accounts, and benefits to the Veterans Assistance Commission of Macoupin County to verify eligibility.

Appeal Rights: If you disagree with the determination of this office, you may file an appeal within nine (9) days if mailed, or seven (7) days if given verbally.

Applicant Signature

Date

Relationship to Veteran (if not the Veteran)

When you’re done: click Print / Save, then bring, mail, fax, or email it to macvac@macvac.org. Our office reviews it and routes it to your Veterans Service Officer — usually within 5 business days.

Or apply with our help

Submitting includes personal information — send it to our office at macvac@macvac.org, or deliver in person, by mail, or fax (217) 716-2311. All submissions go to our admin inbox, where they are reviewed and assigned internally. One-click secure online submission can be enabled when the site goes live.