In-Treatment Support Application
Grants made to families who have suffered financial hardship as a result of a pediatric cancer diagnosis and treatment. 
Sign in to Google to save your progress. Learn more
Email *
In-Treatment Support Criteria
Patient must be 21 years old or younger and have been diagnosed before their 18th birthday.

Patient must be currently in active treatment for childhood cancer.

All information submitted will be verified by authorized treating facility and personnel. Only applicants who have met all necessary requirements will be approved.

Must be a cancer diagnosis.
Things to know before applying:
Applications must be submitted online at danielacontefoundation.org. (Mail links are on our website!)

Applications won’t be accepted by fax or phone.

Funds won’t be distributed directly to the family. Invoices will be paid directly to the provider – i.e. landlord, electric company, bank, etc. with proper accompanying invoice/receipt.

After the family has reached the maximum available funds, they will only be re-eligible for assistance 12 months after their last request.

Please provide a minimum of 30 days before due dates ensure payments are processed in a timely manner.
If your family is requesting assistance with rent:
The following information must be emailed to us:

Name of landlord, rental agent or company to make the check payable to, Amount of rent due, and Mailing address to send check for rent.

If your family is asking for assistance with bills:
If a family is asking for assistance with bills, a clear copy of the statement must be uploaded and sent to our email address at danielacontefoundation@gmail.com.  

The bill must clearly show:

The company’s name, Account holder’s name, Full account number, Amount due, Bill due date, Phone number to call to make a payment, Company mailing address, Account holder’s date of birth, and the Last 4 digits of account holder’s social.

We do not assist with:
Any cases with a diagnosis other than childhood cancer.
Patients diagnosed at the age 21.
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Vida & Partners Digital, LLC. Report Abuse