Assistance Application
At Team Blue Line, our mission is to stand beside the brave men and women of law enforcement who have been injured in the line of duty, and to extend a helping hand to the families of those who’ve made the ultimate sacrifice. Our support is comprehensive: we provide everything from service dogs to financial assistance for critical needs and medical expenses. We’re also here to support officers dealing with PTS care and other challenges. We're honored to serve those who serve us.

We kindly ask that you complete the form below and provide as much information as you’re comfortable sharing. This will help us follow up with you and ensure you receive the care and support that you need.

Please rest assured that any information you provide will be kept strictly confidential and will not be shared without your permission. We appreciate your trust in us as we work together to provide the care and assistance you need.
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Email *
Date of Request *
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First Name *
Last Name *
Email Address for officer/family (if seeking assistance for someone else)
Mailing Address, City, State, Zip *
I am applying for assistance for...
Team BlueLine was formed to provide assistance to persons who serve or have served in a sworn law enforcement role.   Please confirm if you (or the person for whom you are submitting this request) are a current or former law enforcement officer: *
Required
Briefly describe your law enforcement background. Please include the agencies where you served and the length of your tenure at each.
If you’re comfortable, please share a brief overview of the incident or circumstances that led to your injury or post‑traumatic stress. This helps us understand your experience and ensure we provide the most appropriate support.
What type of support are you requesting?
What is your current employment status?
What specific financial challenges are you facing at this time?  What is the approximate amount (dollar) of assistance you are requesting? 
Financial assistance for PTS care requires direct contact from your care provider, as eligibility and financial need must be verified through them. Please have your provider reach out to Team BlueLine directly (clint@teamblueline.org) to expedite support.

Are you currently working with or seeking care from a provider who can initiate this process on your behalf? If so, and if you are willing, please share the name and contact information for your provider.
(We will not contact a provider without your consent.)
Is there anything else you would like for us to know about your situation or how we can best support you?
How did you learn about Team BlueLine?
We’d love to share how Team BlueLine has supported you, but only with your permission. This will help us connect with donors and reach out to other officers and families in need of care. We will share any materials we create with you before they are published.   

In the event that Team BlueLine is able to provide support for you, do you give us permission to share that with our donors as well as potential officers and families we hope to serve? *
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