Request Assistance | Harpswell Santa Fund

Head of Household(Required)

First Last

Address

Street Address Address Line 2 City State ZIP Code

Phone(Required)

Email

Request Type(Required)

Holiday Request (children ages 0-15 years old)

Heating Assistance

Food Assistance

Child One

Child's First Name

First

Child's Age

Shoe Size

Clothing Size

Specific Size

Please write in the correct/specific size for your child.

Desired Item(s)

Child Two

Child's First Name

First

Child's Age

Shoe Size

Clothing Size

Specific Size

Please write in the correct/specific size for your child.

Desired Item(s)

Child Three

Child's First Name

First

Child's Age

Shoe Size

Clothing Size

Specific Size

Please write in the correct/specific size for your child.

Desired Item(s)

Child Four

Child's First Name

First

Child's Age

Shoe Size

Clothing Size

Specific Size

Please write in the correct/specific size for your child.

Desired Item(s)

Heating Request

Have you applied for any assistance programs?

Yes, I was denied or applied too late.

Yes, the funds have been used and I still need help.

No, I did not apply or was ineligible to apply.

Examples may include LIHEAP, General Assistance, or other programs.

Are you currently in arrears?

Yes

No

How much is owed?

What company is owed the amount in arrears?

Here you might enter CMP, your fuel company, etc.

Food Request

Do you receive SNAP benefits?

Yes

No

How many people live in your household?

How many days of food do you need?

An estimate is okay. Consider when your next paycheck comes in or your SNAP card is reloaded. If you're not sure, you can leave this blank.

Does anyone in your household have dietary restrictions?

Please list any dietary restrictions here.

Comments

This field is for validation purposes and should be left unchanged.

Two easy ways to request assistance:

Apply Online

Apply by Paper

Assistance Application

Assistance Request

Child One

Child Two

Child Three

Child Four

Heating Request

Food Request