Please select a designation for your funds:*

[Select...] Cancer Institute Feinstein Institutes for Medical Research Glen Cove Hospital Huntington Hospital Katz's Women’s Health Lenox Health Greenwich Village Lenox Hill Hospital LIJ Medical Center Long Island Jewish Forest Hills Long Island Jewish Valley Stream Manhattan Eye, Ear and Throat Hospital (MEETH) North Shore University Hospital Northwell Heroes Caregiver Support Northern Westchester Hospital Peconic Bay Medical Center Phelps Memorial Hospital Plainview Hospital South Oaks Hospital Southside Hospital Staten Island University Hospital Syosset Hospital Zucker Hillside Hospital Other Designation

If you chose "other" for your designation please let us know your designation.*

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.