Form — Carmine & Robert DeSantis Charitable Foundation

Complete the form to learn more about equipment donations and requests for help.

Name *

First Name

Last Name

Phone Number

Email *

Is the child you're seeking help for under 21 years of age? *

Yes

No

Is the child you're seeking help for a resident of Staten Island? *

Yes

No

Are you able to provide medical proof of the child's diagnosis? *

Yes

No

Are you able to provide a doctor or therapist's prescription for the item or service? *

Yes

No

Is it an item or service that is not covered by insurance and the parents/guardian is unable to financially provide? *

Yes

No

Thank you! A member of our foundation will review and reach out if you meet all the requirements. Please make sure you have all documents ready.

*Required fields

The DeSantis Family Charitable Foundation is a volunteer-only organization.
All proceeds go directly towards helping children with special needs.