Wis. Stats. Chapter 45	P.O. Box 7843, Madison, WI 53707-7843 | 1-800-WIS-VETS (947-8387) | WisVets.com
APPLICATION FOR VETERANS SERVICE ORGANIZATION GRANT
The information requested on this form is authorized for collection by Ch. 45, Wis. Stats., and VA 7, Wis. Admin. Code. The information collected is used to determine eligibility for programs administered by the Department. Completion of this form is voluntary; however, failure to furnish the requested information may result in denial of eligibility for programs. Personally identifiable information collected on this form is not likely to be used for any other purpose. The Department does not discriminate on the basis of race, color, national origin, sex, religion, age, or disability in employment or provision of services.

Pursuant to Wisconsin Statute § 45.41, the	(VSO) hereby applies for a State Veterans Organization Grant for Fiscal Year beginning April 1,	2022	, and ending March 31,	2023	, for the purpose of having provided services and representation to former military personnel, their dependents and survivors in relation to claims for any benefits available from the federal government where such claims have risen out of or by reason of service in the United States Armed Forces.

In accordance with Wisconsin Statute, § 45.41, and/or Chapter VA 7, Wisconsin Administrative Code, an application shall provide evidence of eligibility and the following exhibits, which are included with this application:

A statement of salaries and travel expenses paid to employees who were engaged in veterans claims services activities and who worked in the Milwaukee the VA Regional Office, covering the period, April 1, 2022 to March 31, 2023. The statement shall be certified as correct by a Certified Public Accountant licensed or certified under Wisconsin Statute Chapter 442 and sworn to as correct by the adjutant or principal officer of the State Veterans Service Organization.

A financial statement for your service organization for the previous fiscal year.

If this is your organization’s initial application for this grant, evidence to establish that it or its national organization, or both, has maintained a full-time service office at the Milwaukee VA Regional Office for 5 consecutive years out of the last 10 years.

If this is not your organization’s initial application, an affidavit by the adjutant or principal officer of your service organization stating that a full-time service office was maintained at the Milwaukee VA Regional Office for the entire period of April 1, 2022 to March 31, 2023.

Evidence of claims service during the time-period of April 1, 2022 through March 31, 2023. Documentation of this evidence of claims service shall be provided by completing an Annual Report for Federal Benefits using the WDVA VSO Grant-Federal Benefits Report form provided with this letter.

Consistent with Wis. Admin. Code VA § 7.05, the Department retains the right to request additional information to determine the VSO’s eligibility for the grant. By submitting this application, the below signators designate each has the authority to sign on behalf of the applicant and has the authority to accept funds on behalf of the applicant and agrees to the below Terms and Conditions.

State Service Officer	Commander, Adjutant, or other official designated to sign for the VSO

Wis. Stats. Chapter 45	P.O. Box 7843, Madison, WI 53707-7843 | 1-800-WIS-VETS (947-8387) | WisVets.com

TERMS AND CONDITIONS

APPLICATION FOR VETERANS SERVICE ORGANIZATION GRANT

The contents of this application will become contractual obligations if the applicant is awarded a grant.

By submitting this application, the applicant certifies to the best of their knowledge and belief, the information submitted is true and correct. The applicant understands that if funds are awarded, in addition to any other legal remedies, the funds awarded may be recouped at any time if it is later determined that any information submitted as part of this application was inaccurate or false.

The applicant understands that all application materials must be submitted at the same time as the application. An applicant that does not submit all requested exhibits will be considered to have submitted an incomplete application, and the application will not be evaluated to determine if the applicant satisfies the requirements of Wisconsin Statute, § 45.41, and/or Chapter VA 7, Wisconsin Administrative Code, to be eligible for the grant.

The applicant understands and acknowledges that the Department may make a grant payment to an eligible applicant in an amount equal to 50 percent of all salaries and travel expenses during the previous fiscal year for those employees of the applicant engaged in veterans’ claim service at the VA Regional Office, or $175,000, whichever is less. If the total amount of payments committed to be paid to all eligible applicants, exceeds the amount available for the payments from the appropriation for this grant under s. 20.485(2)(vw), Stats., the Department shall prorate the funds among the applicants receiving the payments.

Pursuant to s. 45.47, Stats., the applicant awarded a grant agrees to maintain records as required by the Department concerning the applicant’s expenditure of grant moneys and agrees to cooperate fully in any review and audit of grant expenditures. In addition to any other legal remedies available to the Department, the Department may recoup any grant funds awarded if the applicant does not comply with the audit.

Any grant funds awarded shall be paid via ACH payment or printed check.

By submitting this application, the applicant certifies that the applicant is compliant with applicable state and federal laws, rules, and regulations, including tax laws and requirements of the grant award.

In connection with the work performed to meet eligibility for this grant, the applicant certifies that it did not discriminate against any employee or applicant for employment because of age, race, religion, color, handicap, sex, physical condition, developmental disability, as defined in s. 5.01(5), Stats., sexual orientation, or national origin. This provision shall include, but not be limited to, the following: employment, upgrading, demotion or transfer, recruitment advertising, layoff or termination, rates of pay or other forms of compensation, selection for training, including apprenticeship.

The applicant understands that this application and other materials submitted to the Department, may constitute public records subject to disclosure under the Wisconsin Public Records Law, s. 19.31, Stats.