Financial Assistance

Guidelines

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.

To request assistance, please fill out this application completely and submit supporting documents (e.g., bills, invoices, quotes, product information, or website) via the file uploader at the end. 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, Allenstown, 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.

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.

Please note:

Failure to complete the form thoroughly or provide supporting documentation may result in delay or denial of the request.
The Board of Directors will deny requests when the amount is not enough to pay an entire bill. Please secure the additional funding before submitting the request. For example, if the Recipient needs $900 to pay back rent and you request $500 from us, please explain how the Recipient will pay the remaining $400.

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.

Financial Assistance Application

About You (the person filling out this form):

Your First Name (required)

Your Last Name (required)

Your Email (required)

Your Phone (required)

Your Address (required)

Your City (required)

Your State (required)

Your Zip (required)

About the Recipient (the person you want to help):

Recipient First Name (required)

Recipient Last Name (required)

Recipient Email (required)

Recipient Phone (required)

Recipient Address (required)

Recipient City (required)

Recipient State (required)

Recipient Zip (required)

Amount Requested (required)

Vendor Name (required)

Reason for need: (required)

Explanation: (required)

Is this a one-time need for assistance or a long term situation in need of other services or assistance? (required)

Please list any other assistance applied for and/or received: (required)

Please attach supporting documentation for this request (PDFs and image files accepted). (required)

If you have additional files, please upload below.

If we are aware of additional options for assistance would you like us to share those with you? (required) YesNo

Are you willing to allow any photos, videos, or interviews for Hearts of Kindness to use in promoting support and fundraising efforts for future recipients? (required) YesNo

Would you like information about becoming a volunteer? (required) YesNo

Would you like to be added to our email and mailing list for newsletters, future Acts of Kindness projects, and fundraising events? (required) YesNo

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:
I have read the above rules before applying.

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

Applicant Signature:

Date:

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Financial Assistance

Guidelines

Financial Assistance Application

Our Programs

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