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Click here to watch - On behalf of the President of the United States Larry Pickett Jr receives the Soldier's Medal!

The Larry Pickett Foundation

a 501(c)(3) nonprofit organization

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Apply for a Survivor Restoration Grant

Survivor Identity & Contact
Applicant Name
Current Mailing Address

The Incident

Date of Incident
In your own words, please share what happened and how it has impacted your family’s stability
Which Fire, Police, or EMS department responded to the scene? We use this to verify the event
Media/Photo Authorization

Financial "Gap"

Primary Financial Need
What is the approx cost that insurance or state benefits will not cover?
e.g., $25,000
Payer of Last Resort Verification

The 85/15 Restoration Model

85/15 Allocation Agreement
Direct-to-Vendor Acknowledgement

Legal & Integrity Disclosure

Conflict of Interest
Certification of Accuracy
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