Validator Application for Assistance
Enter your information below starting with the primary kinship caregiver. When you're done, click the submit button at the bottom of the form. If you're not sure about something, please email info@stepupparents.org
By applying as a validator, you are:
Verifying the child's kinship care arrangement
Confirming the family's need for support
Advocating on behalf of families who may need assistance navigating the application process
Validator's name
*
First Name
Last Name
Validator's organization:
*
Validator's organization address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Validator phone
-
Area Code
Phone Number
Validator email
*
example@example.com
Name of applicant (kinship caregiver)
*
First Name
Last Name
Applicant date of birth
*
(MM/DD/YYYY)
Applicant mailing address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
County
*
Please Select
Belknap
Carroll
Cheshire
Coos
Grafton
Hillsborough
Merrimack
Rockingham
Strafford
Sullivan
Cumberland
York
Applicant email
*
example@example.com
Applicant phone number
*
-
Area Code
Phone Number
Have the biological parents struggled with substance misuse?
*
Yes
No
Spouse's Name
First Name
Last Name
Spouse's Date of Birth
(MM/DD/YYYY)
Household members
*
First Name, Last Name, Date of Birth, and relationship to applicant
Background Information
How many children are in kinship care?
*
How many kids in kinship care
How many kids in kinship care
List any additional resources and assistance not listed that you have received in the last 12 months.
Please tell us about how the applicant came to be a kinship caregiver. Please include information regarding the biological parents involvement with substance use disorder.
*
Please explain the current situation and the reason for the request.
*
Request for Assistance
Please include contact info, account number, and all details to make direct payment.
Kind of assistance
Housing: Rent/Mortgage
Housing: Repairs
Housing: Food
Housing: Furniture
Utilities: Gas
Utilities: Electric
Utilities: Oil
Utilities: Propane
Utilities: Sewer/Water
Utilities: Phone/Internet
Transportation: Car Payment
Transportation: Gas
Transportation: Car Repairs
Transportation: Insurance
Activities: Sports
Activities: Drivers Ed
Activities: Camps
Activities: After-School Activities
Activities: Daycare
Other: Medical Expenses
Other: Clothing
Other: Clothing: Baby Supplies
Other: Indoor/Backyard Activities
Other: Caregiver Respite
Other: Other
Amount of funds requested
*
Payee Info
*
Requested Documents
Invoice/Bill (if applicable)
Browse Files
Cancel
of
Submission Status
Please Select
Review Required
Application Incomplete
Awaiting Information
Approved
Paid
Payment not ready for distribution
Closed
Denied- Requirements not met yet
Denied- Received assistance within 12 months
Acknowledgement Sent
Testimonial Secured
Submit
Should be Empty: