Financial Assistance

Rules for Financial Assistance requests:

Financial assistance requests may be made for up to $500 per individual/family, no more than once every two years, no more than three times per individual/family in a lifetime. In order to request assistance we will need this application filled out completely and submitted with any supporting documents. Please note additional rules may apply based on the nature of your request.

These applications must be completed on behalf of another person by a professional, such as a Doctor, Counselor, Service Provider, Teacher, Social Worker or Clergy. Our current financial assistance areas include: Concord, Penacook, Boscawen, Webster, Loudon, Chichester, Epsom, Pembroke, Bow, Dunbarton, Hopkinton, and Contoocook. 

Recipients cannot currently have any outstanding warrants, be on probation or be incarcerated at the time of the request.

No cash, gift cards, or checks will be given directly to any individual; any monies of assistance will be paid directly to the vendor. If the need cannot be validated this request will be denied. All approvals and denials are at the discretion of the Board of Directors and are also subject to the availability of funds. 

Hearts for Kindness may use your scenario as an example of how we have helped others; however, your personal identity will remain confidential unless we receive permission from you otherwise.

When completing the form, please note that "Applicant" refers to the professional submitting the form and "Recipient" refers to the person or family in need of financial assistance. Please note failure to complete the form thoroughly may result in denial of the request.

Application for Assistance:

This application is being completed by:*
Recipient Name: *
Amount Requested:*
Vendor Name:*
Reason for need:*
Please list documentation to support this request and email documents directly to*
Is this a one-time need for assistance or long term situation in need of other services or assistance:*
Please list any other assistance applied for and/or received:*
If we are aware of additional options for assistance would you like us to share those with you:* Yes   No   
Are you willing to allow any photos, videos or interviews for Hearts for Kindness to use in promoting support and fundraising efforts for future recipients? * Yes   No   
Would you like information about becoming a volunteer? * Yes   No   
Would you like to be added to our email and mailing list for Newsletters, future acts of kindness projects, and fundraising events?* Yes   No   

Check* Hearts for Kindness may use your scenario as an example of our financial assistance program.

By checking here you are stating that you have read the above rules before applying.

By signing this application. I am stating that I have read the rules for the application for assistance and believe all statements I have made above to be true to the best of my knowledge.
Applicant Signature*