Application for Financial Assistance
This application is a request for financial assistance from the Shanerock Foundation for Childhood Cancer. Shanerock’s mission is to focus on providing care, resources, and equipment to local families that are battling pediatric cancer. Shanerock will also fund the efforts of other non-profit organizations that support families and their fight against pediatric cancer.
- The patient must be 18 years of age or under and receiving care for a form of cancer.
- The application request must come from/be completed by the child’s parent/legal guardian
- Please complete all sections of the application truthfully.
- If information is found to be misleading, false, or inaccurate it will result in disqualification of the application.
- Please have section 2 completed by a member of your Oncology team (social worker, RN, or MD).
Send the completed application to: firstname.lastname@example.org