3041 Veterans Rd. West, Suite 2
Staten Island, NY 10309

Fill Out Our Application Online 


Required Documents

In order to complete the application online you will need to provide/upload the following documents:

  • Drivers License/Photo ID
  • Letter from a physician(s) confirming diagnosis
  • Copies of Invoices for payment (if applicable)
  • Copy of 1st page of bank statement (if applicable)


Before you begin please have a rough estimate of your current assets and monthly expenditures as it will be required in the application.

Criteria Of An Applicant

Applicant must be 18 years of age or younger experiencing a medical or living emergency. Applicant must reside in one of the following locations:

Staten Island, NY • Bergen County, NJ • Essex County, NJ • Hudson County, NJ • Middlesex County, NJ • Monmouth County, NJ • Ocean County, NJ • Union County, NJ