Emergency Assistance

Town of Hudson, NH

To be completed at the time of each request for assistance.

By signing the form below, I understand that if I knowingly give false information or withhold information related to my receipt of assistance, now or in the future, I may be prosecuted for a crime and denied future assistance.

form.antibot { display: none !important; } You must have JavaScript enabled to use this form.

Last Name *

First Name *

Middle Name *

Maiden Name (if applicable)

Address: *

City: *

State: *

Phone Number: *

Email Address: *

Have you requested assistance from the Town previously? *

If so, when?

How long have you lived at this address? *

What type of assistance are you requesting at this time? *

What is the name and ages of all household members? *

List all sources and amounts of your household's earned and unearned income. This includes cash, savings and checking accounts: *

Indicate any changes in your personal situation and when did this situation change? *

Signature: *

Date:

edit-submitted-date-month

edit-submitted-date-day

edit-submitted-date-year

Contact Information

Main Level of Town Hall
12 School Street
Hudson, NH 03051
Phone: (603) 886-6000
Fax: (603) 816-1294

Office Hours
Monday - Friday
8:00am - 4:30pm

View Full Contact Details

News

Emergency Resources for Renters and Homeowners