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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.
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* Indicates required question
Name
*
Your answer
Address
*
Your answer
Email
Your answer
Phone
Your answer
What is causing your need?
*
Medical
Special Need
Loss
Poverty Situation
Required
Who is the person affected?
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Please enter name, age, and situations of all members in your household.
Your answer
I am looking for help by:
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Gift cards
Emotional Support
School Supplies
Clothing
Shelter
Financial Support
Resources
Additional...........I will describe in more depth in the following question.
Required
Please give us a brief description of what you need help with?
*
Your answer
What is your annual income?
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We have an income guidelines and will require proof to be eligible for any financial programs.
Your answer
Any Questions, Comments, or Suggestions?
Your answer
*** 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..
*
Yes I understand I may receive a response in 1 - 2 weeks
No
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