Request Assistance
Who Qualifies for Direct Financial Assistance?
- The child must have a diagnosis of cancer.
- The child must be between the ages of 0-18 years of age.
- The family must be experiencing financial challenges as a direct result of the level of care required by their child.
- The Request for Assistance Form must be filled out completely; all information requested is strictly confidential.
- The Request for Assistance Form must be faxed with a cover page by a social worker, nurse, case worker or other healthcare provider who is involved in the treatment of your child.
Review Process
Upon receiving and reviewing the Request for Assistance Form, you will then be contacted by an NTF representative within two days to discuss how we can best help you.
Request For Assistance Form