The Kimberly Fund Application
THE HISTORY:
Kim Troisi-Paton was diagnosed with stage III colon cancer in May of 2005 and threw herself into educating about colorectal cancer (CRC). After being featured in the 2007 Colondar, Kim realized that The Colon Club shared her passion to educate young adults that colorectal cancer can happen to ANYONE at ANY time!

In December of 2006, Kim was diagnosed with an aggressive recurrence, but it didn’t seem to slow her down at all. While going through chemo, she worked tirelessly being an amazing wife, mother, attorney and author. After a 2 1/2 year battle with colon cancer, Kim passed away on August 10, 2007.

The Kimberly Fund was established by Kim’s family and friends as a way to honor her memory. There are no words to express how much she is missed, and how, through the Kimberly Fund, her spirit and dedication will live on.

KIM'S MISSION:
Give children, whose parent or primary caregiver is currently being treated for or has lost a parent or primary caregiver to colorectal cancer, a chance to put the cancer aside, even just for a moment, and be a kid again!

HOW TO APPLY?
Children, with the help of a parent or guardian, whose parent(s) have been affected by colorectal cancer, to fill out this brief application. Applications are reviewed quarterly (March, June, Sept. Dec.). Applicants will be asked to provide proof of their situation (death certificate/obituary or proof of treatment. If we receive your application after the quarterly deadline, it will be added to the next quarters applicants.

WHEN YOU'LL HERE FROM US:
We review applications once a quarter (March, June, September, and December) We will call you if you have been chosen to receive a grant. If your family is not chosen, you will receive a letter and can apply again when the next quarter starts.

Currently the grant recipient will be awarded up to $2,000. Typically 2 grants are awarded each quarter.
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Child's Name: *
Age (must be under 18 yrs.):
 *
Birthdate:
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School Grade: *
Sex: *
Name of parent or primary caregiver with colorectal cancer or that has passed away due to colorectal cancer: *
What age was parent or guardian diagnosed? *
What stage? *
Current age of parent or primary caregiver with  colorectal cancer or that has passed away due to colorectal cancer: *
Date that parent or primary caregiver that passed from colorectal cancer (if applicable):
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Parent/Legal Guardian Name: *
Your relationship to child: *
Address: *
Parent/Legal Guardian's home phone *
Parent/Legal Guardian's work phone:
 *
Parent/Legal Guardian's cell phone:
 *
Parent/Legal Guardian's email address:
 *
Have you previously applied to The Kimberly Fund? *
How did you hear about The Kimberly Fund? *
Are there other children applying? If yes, fill out the following information on additional children. *
Child's Name:
Age (must be under 18 yrs.):
Birthdate:
MM
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DD
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YYYY
School Grade:
Sex:
Clear selection
Child's Name:
Age (must be under 18 yrs.):
Birthdate:
MM
/
DD
/
YYYY
School Grade:
Sex:
Clear selection
What is your grant wish? Be specific about how the money will be spent and how much will be needed. The Kimberly Fund will provide the qualifying applicant(s) up to a $2,000 grant to be used for the wish outlined. 

Please provide a general overview of the specific project that will be supported by the grant, who the participants (if any) would be other than you and provide insight into your own qualifications and resources relevant to the project. You may wish to let the Grants Board know what your inspiration and/or motivation is for the project.
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Tell us a little bit about your child. Why you think this child(ren) should be chosen for a Kimberly Fund grant.
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Is there anything else you would like us to know about the child(ren) and their parent or guardian who has CRC or passed away from CRC?
If you are awarded a grant, are you willing to write a one page summary of how the wish affected the child's life and share a few pictures with us to use/share?
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