Request Assistance (To be completed by a validator only)
Please note that we cannot review requests made by the person who needs the assistance nor can we accept requests from the vendors themselves, such as landlords, auto repair shops, utility companies. We need validators to assess the situation, explore other community resources/funders and provide us with objective information. Once we have all the information, board members will vote on the request for assistance and get back to the validator with the decision. We will consider providing assistance up to $800/every 24 months for people who live in Barnstead, Deerfield, Epsom, Northwood, Pittsfield, and Strafford. The maximum is $400/every 24 months for out-of-area requests. To process requests for assistance, we require you complete and submit the following information:
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Validator's Name, Title & Employer *
Validator's Address *
Validator’s Email *
Validator's connection to client & length of relationship *
Town in which this person/family lives *
Brief description of the need for assistance, as well as any other resources being used or pursued. We would like to hear a detailed account of the client's overall financial situation, including specific difficulties that are happening right now. Has anything recently changed for this client? If they didn't have this expense, would they be able to manage all of their bills? *
Is this a short-term need? What is this person/family doing to secure a more sustainable position? How will this assistance have a lasting impact? *
What is the exact amount being requested? *
What is the full amount that is owed or the amount of the total bill? In other words, how much will still be owed if Catamount Womenaid pays the amount you are requesting? And what will their plan be to pay the rest of the bill? *PLEASE PROVIDE A COPY (EMAIL A PIC) OF THE BILL SO WE CAN VERIFY THE MOST UP TO DATE AMOUNT OWED AND THE HISTORY OF PAYMENTS/NONPAYMENTS. The board will not vote until this is provided. 
The name and ADDRESS of the vendor that will be paid, including account number. Or the store and item number for a purchase – online links are helpful. We will not be able to consider the request until this information is provided. *
Please list all resources and avenues of assistance that have been contacted already relative to this financial need (town welfare, food pantries, community action, 211, Servicelink, churches, etc.). We are a funder of last resort so please make sure you have pursued other assistance options first. 
Towns and cities in NH must give financial help for basic needs like shelter, rent, mortgage payments, heat, lights, gas, water, food, necessary clothing, transportation and prescriptions. Welfare must also help with "maintenance" items such as paper products, household supplies, diapers, etc. Please tell us who your client has already talked to in the welfare department and what was the outcome. Or tell us why welfare wasn't contacted. (If the client lives in Rochester, Somersworth, or Farmington,  please verify that you have already contacted also.)  *
Are you an organization with funds to assist the community? Are you partially funding this request? If yes, please explain why you cannot fully fund the request, and if no, please explain why you are unable to fulfill this request? *
What is the name of the potential recipient? (We will maintain the recipient’s confidentiality but want to be able to track requests.) *
Has Catamount Womenaid helped this person/family in the past? *
If yes above, explanation of how Catamount Womenaid  has helped this person/family in the past. 
Have you applied to another Womenade/Womenaid in NH for this same client in the last 12 months? We will not accept this request if you have already asked another Womenade/Womenaid to help. We might work with them to pay it but they will decide to reach out to us if they want help sharing the request. Feel free to comment. 
Is this request due to financial need resulting from criminal or negligent behavior? *
Explanation of above question re criminal or negligent behavior.
How did you hear about Catamount Womenaid? *
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