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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 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


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 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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