Download Paper Copy of Application
Please read these requirements before completing the application.
1. Any family with a child diagnosed with brain cancer prior to the child’s 18th birthday is
eligible for consideration. We will consider applications received within six months of a child's
2. The applicant must be the parent or legal guardian of the diagnosed child and the primary
caregiver of the child. A photocopy of the child’s birth certificate or other evidence of parental
or guardian status must be submitted with the application. Applicants must be U.S. citizens and U.S. residents.
3. The application must be accompanied by a signed letter from the child’s treating physician on
that physician’s letterhead stating the child’s full name, date of birth, diagnosis and date of
last treatment provided.
4. All sections of the application must be completed and all accompanying documents must be
submitted in order for our Grant Committee to review the request. Failure to provide
complete information is a basis for denial of an application.
5. Assistance may be requested once per calendar year. Each request for assistance requires
submission of a new application.
6. Please contact Grant Committee Chair, Laura Koski, at firstname.lastname@example.org if you
have any questions concerning the application process.