New Hampshire Hospitality Employee Relief Fund Application

Name *

First

Last

Email *

Place of Employment *

Length of Employment *

Position Held *

Annual Income *

Tipped Wage or Salary *

What is your estimated weekly expenses? *

I have received a grant from this fund in the past. *

• Yes
• No

Please make a short statement in regards to your funding. *

Submit

In order to complete your application, please send your two most recent paystubs to Amie Pariseau at apariseau@nhlra.com. Applications will not be considered without two recent paystubs.