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Deceased Service Member
First Name

Last Name

Date of Birth

Date of Death

Cause of Death (Please select one):

Military Unit

Military Branch (required)

Rank

Service Branch (please choose one)

Spouse/Parent/Guardian First Name

Spouse/Parent/Guardian Last Name

Country

Address

Address Line 2

City (required)

State (required)

ZIP Code (required)

US Resident (please select one):

Relationship with the Deceased

Email Address

Phone Number

Preferred Contact Method

How Did You Hear About Us?

Please use this box to specify your selection from above:

Child 1 First Name

Child 1 Last Name

Country (required)

Address Line 1

Address Line 2

City (required)

State (required)

ZIP Code

Relationship to the Deceased (Please select one):

Child 1 Date of Birth

Gender (required)

Email address

Phone Number

Do you currently have undergraduiate loans?

Current VA Benefits

If you chose 'Other,' please explain below:

College Plan

Child 2 First Name

Child 2 Last Name

Country (required)

Address Line 1

Address Line 2

City (required)

State (required)

ZIP Code

Relationship to the Deceased (Please select one):

Child 2 Date of Birth

Gender (required)

Email address

Do you currently have undergraduiate loans?

Current VA Benefits

If you chose 'Other,' please explain below:

College Plan

Partner Opt-In
Fallen Patriots proudly partners with carefully vetted organizations who serve and support military families with additional services we do not offer. By checking this box, you are giving Fallen Patriots permission to share your contact information with our partners in hopes to provide additional resources and assistance to your family. Please be aware that Fallen Patriots does not control how these partners process your personal data. We encourage you to review the privacy policies of these partners for more information about their privacy practices. Partner Organizations Include: Tragedy Assistance Program for Survivors (TAPS) Veterans Benefits Administration (VBA) American Armed Forces Mutual Aid Association (AAFMAA)

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Communications Release (required)
I hereby grant to Children of Fallen Patriots Foundation, and those acting with their authority and permission, the right and permission to use, re-use, publish, and re-publish my name, submitted testimonials, interviews, and photographic portraits, videos, pictures, images and/or likenesses of me. I recognize that I may be included in various Fallen Patriots print and online materials. I allow Children of Fallen Patriots to share this content with third-parties, and I give them permission to use all content obtained at Children of Fallen Patriots events. All rights, licenses and privileges herein granted to Fallen Patriots are revocable at any time. We request that any and all changes to the signed release must be done so in writing at which time we will no longer use your testimonials, interviews and photographic portraits, videos, pictures, images as requested.