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Womenade Request Information Form

Introduction

Please fill this form out completely, with as much detail as possible. This will help the process go smoothly. Womenade of the Hamptons seeks to assist qualified individuals bridge the gap of hardship that they are experiencing in life.

Our current maximum donation is $500.00, at this time we are unable to contribute toward auto repairs, rental payments and utility payments.

What organization is validating this request?

Email:

Name of Recipient:

In what town does the applicant reside?

Has recipient received help from Womenade prior to this request?

Yes

If Yes on above, how much was funded, date funds received, what was the reason for the need?

Does the applicant have family financial support, if so how much and how often?

List name and ages of ALL people living in the home and who is employed

Any grants approved will be paid directly to the vendors

Any grants approved will be paid directly to the vendors, please be prepared to provide a current invoice that is accurate with updated addresses, telephone contact, and description of the item requesting payment.

Verify the exact address, time of delivery, and who is receiving if this is a delivered need. Verify with your client they have given permission for an invoice to be paid, some do not accept unauthorized payments due to security reasons.

How much is the request for? Who will the payment be made to? (please provide account information so we are able to make the payment directly).

What other resources has the applicant sought to meet this financial obligation and what were the results?

Has the applicant contacted the town welfare office of residency as well as their local Community Action for assistance? Results?

Support from Womenade is the last piece in the puzzle, closing the financial gap to meet an unexpected emergency expense.

Support from Womenade is the last piece in the puzzle, closing the financial gap to meet an unexpected emergency expense.

We request all available resources be exhausted before you, as the validator, make this request. This will eliminate duplicating efforts from other supportive agencies.

Opt-In

By checking, You, as the validator, are authenticating your application, we look forward to working with you.

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