Veteran In Need Request Form


Thank you for your service! 

If you are a Veteran in need of assistance, please fill out the form below completely.


A member of our organization will contact you within 48 hours.  Please be as thorough as possible so we can access the best options as quickly as possible. Please be prepared to come in to the VAC on a Tuesday evening between 1800-1900 hrs to go over a plan.

Although we may not be able to help financially, BOTGNY works with caseworkers to assist Veterans that are moving into stable housing from shelters and periods of homelessness. BOTGNY provides furniture, mattresses, food and other needed items. We are also able to assist with special needs such as wheelchairs, ramps, scooter, etc.

Veterans please understand that supplies & furniture are only available if available, so not all requests can always be fulfilled.
Deliveries are done by Volunteers twice a month.
Food, personal care items, hygiene & pet food pantry is available to all Veterans when VAC is open and also available during groups.

Pre Requisite – Be a Honorable Discharged Veteran with Service Connected rating. 

Please also understand that the Volunteers assisting you are also Veterans, many of who are service connected themselves!



Name (required)

Phone Number (required)

Your Email (required)

Address (required)

Date of Birth (required)

Branch & Dates of Service (required)

Service Connected Disability? (required)


Number of People in Household (required)

Age/Sex of Children in Household (if any)

How did you hear about Boots on the Ground NY? / Include name / # of caseworker (if any) (required)

Have you contacted any other organizations for help? (required)


Which Ones?

Name & Contact Information of HUD VASH Caseworker

Please let us know how we can help(required)


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