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-BinaryTotal Number of Household Members*Please enter a number from 1 to 9.Please enter the total number of household members, including the applicant, from 1-9Number of Dependent Children in Household*Please enter a number from 0 to 6.Please enter the total number of minor children residing in the household, from 0-6Additional Information about Household Members included above Senior in Home (65 or older) Dual Head Of Household Veteran in Home Person(s) with Disability in Home Purpose of Grant*RentGas-HomeElectricityOil-HomeTransportationMedicalDentalMoving/StorageAppliancePurpose of Grant-OtherAmount Requested*Please enter a number less than or equal to 1000.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.
