Application for Assistance

General Guidelines for Financial Assistance

All sections of the application must be completed thoroughly and accurately in order for The Give Hope Foundation to review the request. Failure to provide complete and truthful information is basis for denial.

Applicants must be lawful citizens of the United States and must be receiving treatment for their illness in the United States.

Approved applications may qualify the applicant for financial assistance one time. After six months, additional requests may be submitted to The Give Hope Foundation if further financial assistance is needed.

The child who has the medical condition must be 18 years of age or younger, or if older than 18 years of age, must be enrolled in a secondary education program or legal dependent.

  • All reimbursements requests will require the original receipt in order to be eligible for reimbursement.
  • A doctor’s diagnosis, in writing, is required prior to review of the application.
  • Funds are limited and are distributed based, in part, on the family’s income.

If you have question or need further clarification please contact our Family Navigator, Shanlee Waters. If you do not want to complete the secure online form, you may download and print a PDF version here.