Note: This affidavit is to be filled out by homeowners/operators/managers only. 

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

Financial Affidavit for NHCORR Housing Assistance

Please complete the following form to receive the housing assistance awarded to the person named below.

Payment will be made electronically. Please contact 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

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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