September 13, 2016

Request for Aid

Only Womenade of Concord validators may complete funding request applications. So that Womenade of Concord may support as many people as possible, we fulfill each individual's needs once per year. Unfortunately, we are not a long-term solution for people in need. * All requests must keep recipient names anonymous. * Funding is distributed directly to the vendor, and there is a $500 limit on each request. For requests where funds cannot be paid to a vendor, the validator or its organization must purchase the approved items and submit the receipt to Womenade of Concord for reimbursement. * Womenade of Concord trusts that the validator will endorse one request per individual or family per year. To process requests for assistance, validators must complete the information below. If you would like to be considered as a validator for Womenade of Concord and you work within a social service organization serving people living in Concord, Penacook, Bow, Hopkinton, Chichester, Boscawen, Contoocook, Pembroke or Loudon, please contact us.
Validator's Name *
Validator's Agency
Validator's Email Address
Validator Preferred Phone *
Town & zip code of the person in need *
Please describe the situation and reason for request. Be as specific as possible. *
Is this need a result of criminal behavior?
Amount of request *
Name, address and account number (where applicable) for vendor.
Vendor Phone Number *
Please list service agencies or providers that have been contacted for support and describe help offered. Please be as detailed as possible.
If your client is unemployed, please indicate what the client is doing to secure work.
Has Womenade of Concord provided assistance to this individual in the last 12 months?
If so, when.