Lend A Hand Agency Grant Application "*" indicates required fields Step 1 of 2 50% LAH strives to help as many people as possible, but we cannot fund all the requests we receive due to funding constraints. Due to the number of requests we receive, we do not provide individual approval determination for each request. If your client’s application is approved, you will receive a check for the requested expense for you to forward directly on to the vendor. All applications are considered on a rolling basis. Email us to inquire about the status of your request if you have questions or concerns.Agency Name*Agency Address*City*State*MassachusettsOtherZip*Grants are only available to Massachusetts residents. Out of state residents are automatically denied.Agency Representative*Agency Representative Job Title*Agency Contact Phone*Agency Contact Email* Next, please tell us about your client in need.Client Name (for whom Agency Is applying)* First Last Client Address*Client City*Client State*MassachusettsOtherClient Zip*Grants are only available to Massachusetts residents. Out of state residents are automatically denied.Client Age*Gender*FemaleMaleNon-Binary/OtherSpecial Circumstances Senior in Home Dual HOH Veteran Disabled Number of Children in Household*Number of Household Members*Purpose of Grant*RentGas-HomeElectricityOil-HomeTransportationMedicalDentalMoving/StorageApplianceOtherPurpose of Grant-OtherAmount Requested*Amount Owed*Checks Should be Issued To*Checks cannot be made directly payable to the clientAccount Number for Utilities or Other*Situation*Please do not include any sensitive personal information, such as social security number, driver's license number, passport number, or other government issued identification numbers; financial account numbers, credit or debit account numbers; sensitive medical/mental health information, etc.Other organizations you are seeking help from*Cover LetterAccepted file types: pdf, doc, docx, Max. file size: 512 MB.Please do not include any sensitive personal information, such as social security number, driver's license number, passport number, or other government issued identification numbers; financial account numbers, credit or debit account numbers; sensitive medical/mental health information, etc. Δ