The Chestnut Foundation is a non-profit organization dedicated to providing assistance to families who have multiple disabled children. We determine
eligibility of these families by application process. Upon verification of this information, we contact the families to conduct interviews of each family member,
their friends and their neighbors. Once the interview is conducted, we proceed with aid to these families, based on their immediate needs. To achieve our
goals, we host fund raising events throughout the year to raise funds to help support these families in their time of need. All proceeds go to aid these
families in the support, welfare, and care of their children. This aid is in the form of financial assistance, medical supplies, adaptive equipment, and personal
assistance is applying for government aid.

All information obtained is strictly confidential . The information which you provide will be used exclusively by the Foundation to determine your eligibility for
assistance. The Foundation will not disseminate or release the provided information to outside sources without first obtaining prior express written consent.
The following information is being submitted by the applicant in consideration of possible assistance.