Assistance Application

Do You Need Assistance?

Our mission is to provide emotional or financial support to cancer patients and their families as well as assist in educational and preventative care programs in the Montgomery County area. If you or a family member need assistance from our organization, there are only 3 simple requirements:

  • The patient is currently receiving cancer treatments
  • The patient resides in Montgomery County
  • The patient and/or family member must complete the application
  • All applications are reviewed and the extent if any assistance is a board decision.

A volunteer will be assigned to you and you will be notified if we can help. We are a small organization and our funds are limited, but assisting patients with cancer in Montgomery County is our highest priority.

Download the application here.  Once you have completed the form, mail it to us and you will be contacted by one of our volunteers