Dear Member -
Thank you for contacting the Long Island Chapter of the National Multiple Sclerosis Society. Enclosed is a set of the financial assistance forms that you will be required to complete in order to participate in any of the following financial assistance programs.
- air conditioner - obtain one from the Chapter or receive funding toward the purchase of a new one.
- computer access - receive a used computer and two (2) hours of training.
- durable and non-durable equipment - assistance with purchasing equipment.
- grocery shopping service - receive help with delivery fees for home delivery of groceries.
- house cleaning - help with house cleaning fees.
- ramp - funding for the construction and installation of a ramp.
- respite - funding for home care companion service.
- See Me Smile - salon/barber for a special event. HOMEBOUND & NURSING/ASSISTED LIVING FACILITY RESIDENTS ONLY . (If you are a CHILD of a parent with MS, this program may be able to assist you with your PROM DRESS/TUXEDO RENTAL in addition to the salon.)
- transportation - help with car service fees to doctors appointments.
The following are required to apply for financial assistance.
Financial Assistance Application. This information will help determine the amount of financial assistance we can provide and will be kept confidential.
Please have your physician complete and verify the Multiple Sclerosis Diagnosis Confirmation Form.
Should you need assistance with equipment, we require a prescription on a prescription pad or letterhead from a physician for the requested equipment.
- Please complete and sign the Wavier of Responsibility form.
IF YOU ARE APPLYING FOR EQUIPMENT, HOME MODIFICATION, OR RAMP ASSISTANCE YOU WILL NEED TO COMPLETE THE APPROPRIATE PROGRAM APPLICATION (see below).
If you have any questions, please contact us at 516.740.7227 or 631.864.8337.
Please complete the preceeding forms and return them to:
National Multiple Sclerosis Society
Long Island Chapter
40 Marcus Drive, Suite 100
Melville, NY 11747
The Programs Department