Pediatric Oncology Family Fund

Helping struggling pediatric cancer families in their time of need.

Request Family Assistance

A childhood cancer diagnosis can place an unexpected emotional and financial burden on the entire family. The Pediatric Oncology Family Fund provides practical assistance to help eligible families focus more fully on their child’s care and well-being. Our goal is to offer a hand up during an extremely challenging time such as with food, gas, utilities, clothing, etc.

Please complete this form with as much detail as possible so our team can thoughtfully review your request. Applications must be submitted by a parent, legal guardian, or authorized adult, and all information will be handled with care and discretion. Applicant must agree to release basic health care information so that we can confirm your status.

Applicant Families must reside in East Tennessee. Patient must be pediatrics (0 to 18 years old) and be in active oncology treatment or completed treatment in the last 6 months.

Please enter your full name.
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Mailing Address
Please provide your complete mailing address.
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Country
Please enter a valid phone number.
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Enter the number of family members.
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Please provide details of the diagnosis.
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Please provide the name of your oncologist.
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Please provide the name of the treatment hospital.
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Please describe what you need assistance with.
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Please specify the amount requested for assistance.
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If applicable, please provide the name of your social worker.
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Any other information you wish to provide.
I certify that I am at least 18 years old and am the patient, the patient’s parent or legal guardian, or otherwise legally authorized to submit this request. I certify that the information provided is true and complete to the best of my knowledge.
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I have read and agree to the Privacy Notice - https://lightyourcandle.org/privacy-policy I consent to Pediatric Oncology Family Fund collecting, using, securely storing, and sharing the information in this application with its authorized staff, reviewers, service providers, and funding partners only as reasonably necessary to evaluate, verify, and administer my request.
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I authorize Pediatric Oncology Family Fund to contact me and the oncologist, treatment hospital, or social worker identified in this application to request verification of the information provided. I understand that submitting an application does not guarantee assistance and that funding decisions are subject to eligibility, available funds, and program discretion.
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I agree to receive application-related emails and text messages at the contact information provided. Message and data rates may apply. Message frequency varies. Reply STOP to stop text messages. Consent is not a condition of receiving assistance.
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