Champions Can! Foundation for Cancer Wellness, Inc. Client Assistance Form
Please complete this form in its entirety. Applicants must be a resident of the state of Georgia.
Information provided for the FINANCIAL and VOLUNTARY INFORMATION sections of this form will not be used in determining whether a grant/assistance will be provided by Champions Can! It is being collected to assist Champions Can! Foundation in demonstrating our community impact when seeking funding to support the foundation. Champions Can! does not discriminate on the basis of race, religion, age, nationality, gender or ethnicity. Information about a specific individual will not be shared.