HOTH Request Form

To request assistance from the NH Patriot Guard Riders please fill out the following form or contact our HOTH Coordinator, Mo Shyne, at [email protected]

HOTH Request Form

Questions marked with an asterisk (*) are required.

Please provide your email address.
Please provide the best phone number to contact you.

The NH Patriot Guard Riders HOTH Program is reliant on donations and therefore each request received is reviewed on a case by case basis.

After we have received your request our HOTH Coordinator will be in touch with you to review the request and obtain additional information if required.

All requests will need to have service eligibility verified (copy of DD-214) before we can proceed with the request. Keep in mind that the NHPGR does not give out cash, all assistance is in the form of gift cards or payment of bills.

Name of the Veteran/First Responder requesting assistance.
Phone number of the Veteran/First Responder requesting assistance
Street Address, City, State & Zip
Please select the branch of service. If more than one applies please note that in the field below.
Select any that apply.
Select the most recent that appllies. If more than one applies please note that in the field below.
Is the request service related?
Please provide a detailed explanation of the request.