Greater Bedford Womenade

Only GBW's validators may complete the funding request application

Individuals seeking support should click here.

Validator Funding Request Form

1. Complete the information below in the grey boxes.

2. Scan or email a copy of the vendor's invoice or written estimate for service or item requested. This will enable timely distribution of funds for approved applications.

3. Complete the release form which you can access by clicking here and then return it to GBW by scan, email, or U.S. mail after submitting the application.

Validator's Name
Validator's Agency
Validator's Email Address
Validator Preferred Phone
Client's Full Address including zip
Please describe what event or circumstance occurred that caused a crisis, a sudden upheaval, in your client's life. Be as specific as possible.
How is your client prepared to address the financial needs of the next few months ahead?
If your client is unemployed, please indicate what the client is doing to secure work.
Please list service agencies or providers that have been contacted for support and describe help offered. Please be as detailed as possible.
What is the total amount of funds needed? If the total is more than $500, please indicate specifically where the remaining funds are coming from.
What are the funds for? Ex: electric bill, prescription drugs, furnace repair, etc.
Can the bill or vendor be paid direcly?
- Yes
- No
For requests where funds cannot be paid to a bill or vendor directly, the validator or its organization must purchase the approved items and submit the receipt to GBW for reimbursement. Are you prepared to do so?
Name and address for vendor payment..
Client First Initial, Last Name and Account # with vendor or other identifying information so payment is credited properly.
Vendor Phone Number
Have you received funding for this client from GBW within the last 12 months?
- Yes
- No
Has the person in need signed GBW's Release?
- Yes
- No
Please submit bill or written estimate from vendor or any supporting documentation of charges that you are asking for reimbursement
- Yes I am sending via email or snail mail
- No I do not have supporting documentation
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Thank you for contacting GBW. Your application has successfully submitted. We will get back to you as soon as possible

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If you would like to be considered as a validator for GBW and you work within a social service organization serving people living in Bedford, Goffstown, New Boston or West Manchester, please click here.

NOTES TO VALIDATORS AS YOU FILL OUT THE FORM:

So that GBW may support as many people as possible, we fulfill each individual's needs once every 12 months.

Unfortunately, we are not a long-term solution for people in need.

Please Note: GBW will only fund requests for clients who live in the following zip codes: 03110, 03045, 03102 and 03070.

GBW prides itself on maintaining client confidentiality. For payment purposes, we do ask for identifying information (First name initial, last name and account number for accurate payment).

Funding is distributed directly to the vendor, and there is a $500 limit on each request.

For requests where funds cannot be paid to a vendor, the validator or its organization must purchase the approved items and submit the receipt to GBW for reimbursement.

We consider requests for funding that fit within our mission statement and definition of crisis, both posted below.

GBW is no longer funding car repairs.

Our Mission Statement:

GBW strives to provide immediate, short-term financial assistance to members of the local community in crisis,* recognizing other means of support may not be readily available. Further, we strive to periodically support existing or new programs that benefit at-risk populations in our service area that aim to avert crisis.

Our Definition of Crisis:

A sudden change that creates financial, social or emotional upheaval that needs urgent action to enable relief.

Greater Bedford Womenade

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