Senior Dreams Come True – Wish Request

Granting Wishes for Long Island’s Low Income Seniors

Sponsored by Cona Elder Law Charitable Events

WISH REQUEST

Please grant a wish for (name):
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Address:
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Phone #:
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E-mail address:
_________________________________________________

Individual submitting request (if different):
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Address:
_________________________________________________

Phone #:
__________________________________________________

E-mail address:
__________________________________________________

ELIGIBILITY Qualifications

Age:  Applicants must be age 65 or over

Income Limits:  Income must not exceed $1,800 per month for a single individual; $2,500 per month for a married couple

Attach the following materials to this application:

1.         A letter or statement describing the needs of the senior and providing reasons why the senior’s wish should be granted (not to exceed 750 words).

2.         Proof of age (i.e. copy of driver’s license, passport or birth certificate)

3.         Proof of all sources of income (i.e. copy of Social Security check, pension check or income statement, bank statement with direct deposit, or tax return)

4.         Sign the attached Certification.

Application deadline:  Applications are welcome any time throughout the year and will be granted on a revolving basis.

Mail application to:      
Senior Dreams Come True
c/o Cona Elder Law PLLC
225 Broadhollow Road, Suite 200
Melville, New York 11747
Attention: Jennifer B. Cona, Esq.

OR e-mail to: elder@conalaw.com (please indicate Senior Dreams Come True in the subject line)

Senior Dreams Come True

Certification

I hereby certify that all of the statements contained and information provided in this application, and in the attachments hereto, are truthful, to the best of my knowledge, and that I (or the person I am nominating) meet the eligibility qualifications to be granted a wish through Senior Dreams Come True.

I hereby grant permission for my name, photo and story to be included in any reputable media including newspaper, magazine, TV, radio as well as posted on the Cona Elder Law website.  In addition, if requested, I agree to be interviewed by print and broadcast media.    

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Applicant’s Signature

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Date