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Request for Emergency Diaper and Formula Assistance

This form is for families with infants who are urgently in need of formula, diapers, or wipes and have no other immediate means of obtaining them. Please complete this application if you are facing a critical gap in these essential baby care supplies so we can assist you as soon as possible.

Please note: Once an emergency formula and diaper assistance request has been fulfilled, another request cannot be considered for a period of 2 months.

Your request has been received!

Thank you for contacting Summer’s Sunshine! A member of our Assistance Request team will reach out shortly.

Applicant Information

First name(required)

Last name(required)

Email(required)

Phone number(required)

Preferred Method of Contact(required)

Mailing Address

Household Information

This information enables us to make sure the amount of aid we supply is enough to support all in need and helps us quantify our impact at the end of the year (i.e., be able to put a number to how many people we helped in a year).
This info is never shared with any other parties and is never used to determine whether aid is needed.

Number of people in household(required)

Number and ages of infants in need of formula and/or diapering items(required)

Housing Situation

Household Income

Other public assistance received (select all that apply)

SNAP WIC Food pantries Other

Need-Specific Details

Please describe your hardship and how Summer’s Sunshine can help address your urgent need.(required)

What items are being requested?(required)

Formula Diapers Wipes

For formula requests, please specify type. For diapers, please list size and brand preference (Please note: diaper brand preference will be considered but not guaranteed as this is based on availability)

Prior Assistance History

Have you received assistance from us before?(required)

Yes No

If so, when and for what?

Referral/Discovery

How did you hear about us?

Consent & Signature

Do you consent to be contacted?(required)

Yes No

I attest that the information provided is accurate (required)

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Summer's Sunshine

We’re a northern Virginia-based 501(c)(3) non-profit organization providing nutritious meals, basic necessities, and other means of tangible support to at-risk mothers and young children.

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