Hope Floats Long Island Inc.
Please fill out what you are comfortable sharing. All information is confidential. Please note- Our programs are for families with children under 18.
Name *
Address *
Email
Phone
What is causing your need? *
Required
Who is the person affected? *
Please enter name, age, and situations of all members in your household.
I am looking for help by: *
Required
Please give us a brief description of what you need help with? *
What is your annual income? *
We have an income guidelines and will require proof to be eligible for any financial programs.
Any Questions, Comments, or Suggestions?
*** Please confirm that you understand Hope Floats Long Island may take a week or two to contact an individual. We would love to try to accomodate each individuals need and we will try our best to do so.. *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy