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Supporting Northwell Health Foundation
Your Donation
Donation Option
*
One-Time
Donation Amount
*
Donation Amount
*
$
/
Maximum Amount to Donate (Optional)
$
Total
Please select a designation for your funds:
*
[Select...]
Child Life
Clinical Support
COVID-19 Support
Family Support Programming
Pediatric Capital
Pediatric Research
Unrestricted Support
Please give us the name for support:
*
Name of family support program
*
Are you a Northwell Health Employee?
*
[Select...]
Yes
No
What is your connection to our mission?
*
[Select...]
I am a grateful patient
I am a relative of a grateful patient
I am a Northwell Health employee
Other
If you selected "Other" please provide more detail below.
How did you hear about us?
*
Northwell Website
Social Media
Northwell Health E-Mail
Other
If you selected "Other" please tell us how you heard about us.
Corporate Giving
Individual Gift
Gift on behalf of my company
Employer Name
Company Name
Payment
Payment Method
*
{accountType} ending in {accountLastFour}
{accountType} ending in {accountLastFour}
Choose a different way to pay
Choose a different way to pay
Contact Details
Name
*
First Name
Last Name
Show my name as (Optional)
Email
*
Title
*
[Select...]
Mr.
Mrs.
Ms.
Miss
Dr.
Prefer Not To Say
Middle Name
Donate with Credit Card
Donate {amount}
Donate with Bank Account
Venmo
description
Yes! I’d like to cover processing costs. (
per month
per year
per
)
Set a time limit on monthly donations?
*
No
Yes
Donate for
*
Months
Enter a duration between 2 and 99 months.