Online Application

Apply for Assistance

Hearts with Hope is here for Woonsocket High School alumni and their immediate family members during difficult times. Please complete all required fields marked with *.

All information provided on this application is kept strictly confidential and will only be used by Hearts with Hope to evaluate your request for assistance.

Applicant Information

First Name*

Last Name*

Date of Birth

Phone Number*

Email Address

Street Address*

City*

State*

ZIP Code*

Woonsocket High School Alumni Connection

Your Relationship to a Woonsocket High School Alumni*

Alumni's Full Name (if not yourself)

Alumni's Graduation Year

Household Information

Number of People in Household

Annual Household Income

Household Members / Dependents

List all other people living in your household (spouse, children, other dependents).

Monthly Income & Expenses

Please list all sources of monthly household income and your monthly expenses. Enter 0 for any that do not apply. This information helps Hearts with Hope understand your financial need.

Monthly Income Sources

Wages / Salary

Social Security

Disability (SSI / SSDI)

Unemployment Benefits

Child Support / Alimony

Public Assistance / SNAP / RIW

Fundraising Campaigns (e.g. GoFundMe)

Other Income — Description

Other Income — Amount

Total Monthly Household Income

Monthly Expenses

Rent / Mortgage

Utilities (electric, gas, water)

Phone

Food / Groceries

Transportation (car, gas, bus)

Medical / Prescriptions

Child Care

Cable / Internet

Other Expenses — Description

Other Expenses — Amount

Total Monthly Expenses

Your Situation

Type of Situation*

Date of Diagnosis or Event

Please describe your situation*

Please provide details about your medical condition or catastrophic life event and how it has impacted you and your family.

Assistance Requested

Amount Requested*

Supporting Documentation

Please upload any documents that support your request (e.g. medical bills, diagnosis letter, utility shutoff notice, pay stubs). Accepted formats: PDF, Word, JPG, PNG — max 10 MB per file.

Click to select files or drag & drop here

PDF, Word, JPG, PNG · Up to 10 MB each · Up to 10 files

Prefer to send documents by email?

You may also email copies of your supporting documentation directly to [email protected]. Please include your full name in the subject line so we can match your documents to your application.

Important: Your application will not be reviewed or voted on until all supporting documentation has been received.

Additional Information

Financial Guidelines

Before submitting your application, please review the Hearts with Hope Financial Guidelines. These guidelines explain how assistance decisions are made, what documentation may be required, and what applicants can expect during the review process.

HWH Application Financial Guidelines

Open / Download

I have read and understand the Hearts with Hope Financial Guidelines, and I agree to the terms and conditions outlined therein.*

Certification & Signature

Please note: Applications will not be reviewed or voted on until Hearts with Hope has received copies of all supporting documentation.

Important Disclaimer — Please Read Carefully

You may be required to provide further information to include, but not limited to, a full disclosure of assets and financial information, criminal records, etc. This may include copies of financial records such as tax returns and bank statements.

Refusal to provide this information is the right of the requester/beneficiary; however, the request for assistance will be denied.

Any willfully false information provided will result in the termination of any award and demand for a return of any funds already paid.

I have read and understand the disclaimer above. I acknowledge that additional documentation may be required, that refusal to provide it may result in denial of my request, and that any willfully false information will result in termination of any award and demand for return of funds.*

By submitting this application, I certify that the information provided is true and accurate to the best of my knowledge. I understand that Hearts with Hope will review this application and that submission does not guarantee assistance. I authorize Hearts with Hope to use this information solely for the purpose of evaluating my request.

I certify that all information provided in this application is true and accurate to the best of my knowledge.*

Full Name (Signature)*

Date*

Prefer to submit by mail or email? You can also download the PDF application.