KIA/Disabled Descendant Registration Form

KIA / 100% Disabled Registration for Scholarship Benefits

This application is for registration of descendants of the following named soldier, a veteran of service with the 1st Cavalry Division, for 1st Cavalry Division Association scholarship benefits:
Name of Soldier*
Unit and Dates When Assigned to the Division*
Date of Death or Percent of Disability*
Widow Certification
- I certify that I am the widow of the above-named Soldier. The persons named below are his children. Copies of their Birth Certificates, Selective Service Card (Male Child Only), a copy of his Casualty Report, documentation of his assignment to the 1st Cavalry Division at the time of his death and documentation of his membership in the 1st Cavalry Division Association, if death occurred in peacetime, are attached.
Disabled Service Member Certification
- I certify that I am totally and permanently (100%) disabled as a result of wounds received or disease contracted while I served with the 1st Cavalry Division
Service Area (Check One)
- Vietnam War
- Desert Storm
- Iraq/Afghanistan Campaigns
The persons named below are my children. Copies of their Birth Certificates, documentation of my assignment to the 1st Cavalry Division documentation of my disability in the degree shown above and proof that the disability resulted from wartime service with the 1st Cavalry Division are attached.
Name(s) and Address of Child(ren)
Child's Name, Address, Birth Certificate, Selective Service Card (Male Only)
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Student SSN*
0 of 9 max characters
Required by IRS.
Student ID # (if applicable)
0 of 9 max characters
Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Student SSN*
0 of 9 max characters
Required by IRS.
Student ID # (if applicable)
0 of 9 max characters
Birth Certificates Attachment Upload(s)
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Accepted file types: jpg, gif, png, pdf, Max. file size: 512 MB, Max. files: 4.
Service Documentation Attachment Upload(s)
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Accepted file types: jpg, gif, png, pdf, Max. file size: 512 MB, Max. files: 12.
Widows please provide: Documentation of his assignment to the 1st Cavalry Division at the time of his death and documentation of his membership in the 1st Cavalry Division Association, if death occurred in peacetime.

100% Disabled Applicants please provide: Documentation of your assignment to the 1st Cavalry Division, documentation of disability (VA Letter) in the degree shown above and proof that the disability resulted from wartime service with the 1st Cavalry Division. Disabled Applicants must be members of the Association.
Additional Required Document Attachment Upload(s)
Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 512 MB, Max. files: 12.
Additional Required Documents such as Active Duty Form 10 to be filled out by the attending academic institution.
I understand that I will receive confirmation of registration for each eligible child and that I must keep the Foundation informed of each child’s current address, that each registered child must make application for a scholarship grant upon acceptance at a recognized institution of higher education, and that eligibility based on disability must be re-validated at the time of application. Application forms are available from the Foundation.
Applicant Digital Signature
Applicant's Email*
Applicant's Phone*
Applicant's Address*
Street Address Address Line 2 City State ZIP Code
Applicant Comments or Questions
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Highlights - CTA

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