Request Assistance (To be completed by a validator only)
We regret that we cannot review requests made by people on behalf of themselves, or requests from the vendors to be paid (i.e., a landlord, an oil company). Validators are necessary because they help us make sure that we are not duplicating efforts of other organizations in our community. Validators provide us with the information we need to make an informed and timely decision. Once all the information we need has been received, board members will vote on the request for assistance and get back to the validator with the decision that has been made. To process requests for assistance, we require you complete and submit the following information:
NAME OF VALIDATOR & TITLE *
Your answer
ORGANIZATION AND ADDRESS OF VALIDATOR *
Your answer
EMAIL *
Your answer
Town in which this person/family resides *
Your answer
Brief description of the need for assistance, as well as any other resources being used or pursued. *
Your answer
Is this a short-term need? What is this person/family doing to secure a more sustainable position? How will this one-time assistance have a lasting impact? *
Your answer
What is the exact amount being requested? *
Your answer
What is the full amount of the amount owed or the amount of the total bill? In other words, how much will still be owed if Catamount Womenaid paid the amount you are requesting?
Your answer
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. (WE PREFER TO TRY TO KEEP THE IDENTITY OF THE PERSON BEING HELPED ANONYMOUS, IF POSSIBLE.) *
Your answer
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? *
Your answer
Has Womenaid helped in the past? *
Explanation of how Catamount Womenaid or any other Womenaid/Womenade helped in the past.
Your answer
Is this request due to financial need resulting from criminal or negligent behavior? *
Explanation of above question re criminal or negligent behavior.
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy