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Application

Apply for a
brighter future

Empower your family’s future by applying for our support services today.
Let us provide assistance and create a brighter tomorrow for your loved ones.

Your Information

Parent/Legal Guardian Name*

Date*

Email*

Phone Number*

Street Address, House number etc*

Landmark, Floor, c/o

City*

Country*

State/Province*

Zip/Postal Code*

+ 4

Child's Name*

Child's Date of Birth*

Diagnosis Type*

Type of Funding Needed*

Tell Us More About Your Situation*

How Did You Hear About Us?*

File Upload: Diagnosis verification letter. (PDF)
The diagnosis verification letter for your child must come directly from the social worker at their treatment hospital. The letter must contain your child’s name, date of birth, a confirmation of their cancer diagnosis, treatment status, name and contact information of the staff member providing the letter, their signature, dated within 1 month of assistance application date and must be on the hospital letterhead.*

Max number of files : 1

Max File Upload size of each file : 5 MB

Application

Apply for a brighter future

Apply for a
brighter future