Privacy & Confidentiality Notice:
Your information is kept strictly confidential in accordance with HIPAA privacy regulations. This is a no-judgment zone—please answer honestly so we can better understand your needs. Submission does not guarantee approval. Please allow 1–3 business days for review and follow-up.

By submitting your application, you authorize the Sergeant Colton Levi Derr Foundation and its designated personnel to review and transmit your information internally for the sole purpose of assessing your eligibility for support. You are not required to provide personally identifiable or health-related information (“PHI”); however, omitting specific details may limit our ability to fully evaluate your request. The Foundation will not use or disclose your information for marketing or receive any remuneration for its use. All personal information will remain confidential in accordance with HIPAA privacy regulations and will not be shared with any third party without your explicit written authorization. To expedite your application, please submit your DD214 and, if applicable, your VA Disability letter to the following email address: gallantlyforward@sergeantderrfoundation.org.

Rest assured that your application will be reviewed promptly. Remember, you are not alone—Stay Strong!