Note: This affidavit is to be filled out by homeowners/operators/managers only, and should be the last form that is completed in order to receive assistance.

Please ensure that NHCORR has received your resident's award letter and housing agreement before completing this form. If the resident left your home early, contact admin@nhcorr.org to discuss partial payment.

If you are a resident or soon-to-be resident of a recovery home and you are trying to apply for housing assistance, please click here. 

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Financial Affidavit for NHCORR Housing Assistance

Please complete the following form to receive the housing assistance awarded to the person named below.
Has or will this resident receive housing assistance from other sources?

Payment will be made electronically. Please contact admin@nhcorr.org to provide banking information.

I understand that I am affirming that the information provided above is complete and true. If it is determined that the above information is incomplete or untrue with an intent to commit fraud, the above named recovery residence may be placed on probation or have its certification removed by NHCORR

Thanks for submitting!

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t: (603) 715-1514

e: admin@nhcorr.org

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NHCORR is a tax exempt 501(c)(3) nonprofit organization, based in Concord, NH. 
Tax deductible contributions may be mailed to:
NHCORR, 2 1/2 Beacon Street, Box A-3, Suite 163, Concord, NH 03301

*The preparation of this website was financed under a Contract with the State of New Hampshire, Department of Health and Human Services, with funds provided in part by the State of New Hampshire and/or such other funding sources as were available or required, e.g., the United States Department of Health and Human Services.*

© 2020 by the New Hampshire Coalition of Recovery Residences