Emergency Financial Assistance Request 
For New Hampshire Residents Only. Please complete this application only if you are in an immediate need of assistance with paying your rent (including rental arrears), utilities (must have a shut off notice), or affording food. After submitting your request, the NEP House of Praise Community Outreach Program Review Committee will reach out to you. Please be advised that supporting documents may be required before a determination is made.
Email *
Applicant's Name *
Current Address *
Email *
Phone number  *
Preferred Language (English, Spanish, French, etc.)  *
What type of assistance do you need? Select All That Apply 
 *
Required
How much assistance do you need? (dollar amount)*
 *
This section must be completed by ALL applicants who have permanent housing. If you are homeless or in transitional housing, put N/A. 

For ALL household members please list (1) Full Name (2) Relationship to the head of household (3) Date of Birth (4) Age (5) Sex
 *
If you and/or anyone in your household receives wages from employment, SSI, SSDI, and/or unemployment please list their name and amount received monthly.
If you owe rental arrears or utility arrears, why have you been unable to pay?
If applicable, please provide us with contact information for your landlord or property manager (name, address, email address and phone number).
If there is anything else you would like the committee to consider while reviewing your application, please comment below.  
A copy of your responses will be emailed to the address you provided.
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