How to Apply for a Wish

Families or social workers interested in submitting an application for a wish from the Marty Lyons Foundation, must first ensure that the child meets our eligibility requirements.

ELIGIBILITY

• The Marty Lyons Foundation (MLF) grants wishes to children, ages 3-17, who have been diagnosed with a terminal or life threatening disease.
• Child must reside or receive medical treatment within the Foundation’s designated geographic locations:
  • Alabama
  • Connecticut
  • Florida
  • Georgia
  • Maryland
  • Massachusetts
  • New Jersey
  • New York
  • North Carolina
  • Pennsylvania
  • South Carolina
  • Texas
  • Virginia
• While MLF does accept 2^nd wish applications, a 2^nd wish is only granted under exceptional medical circumstances.  Typically, this 2^nd wish will not be granted if the prior wish was completed less than 24 months ago.

 

 

INSTRUCTIONS

 

• Four (4) forms are required
  • Parent’s – To be completed by the child’s parents
  • Physician’s  – To be completed by the child’s doctor
  • Release & Indemnification – To be completed by the child’s parents and notarized
  • Authorization to Release Protected Healthcare Information – To be obtained directly from the child’s medical facility and completed by the child’s parents
• Upon completion, all four (4) forms are to be mailed to MLF’s headquarters
  • The Marty Lyons Foundation; 354 Veterans Memorial Hwy; Commack, NY 11725

Downloadable Application Files:

Application Instructions

Parent Application Form

Physician Information Form

Release and Indemnification Form

 

FOR MORE INFORMATION

FAQ's

Please call us at 631-543-9474 or send us a message