Request an Application

If you meet the listed eligibility requirements, please ask your physcian’s office, oncology department or social worker to request an application.

Requests will be honored only during our open period.

We are hopeful that past recipients and their families will help spread our pursuit and pay it forward to help another and to keep the circle of giving going…

Eligibility Requirements:

  • You are a young adult between the ages of 16-36.
  • You are personally undergoing treatment or have finished protocol (within 8 months) for a rare cancer.
  • You are a citizen of the United States.

Important Dates

  • Applications distributed June 17, 2019 – July 8, 2018

Please note that due to its high prevalance, breast cancer in your twenties is considered rare.

Check for more details: 

Contact for further questions.