Nominate a Recipient

GRANT GUIDELINES

*Patient must be active in treatment, chemotherapy, radiation, bone marrow transplant, hospice or palliative care and surgery when the recovery period is in excess of Four weeks.

*patient must be 18 years or older

*nominating person and patient receiving grant must sign release form (if selected to receive grant)

*Patient may only receive assistance only once every 24 months.

*She Will Fight approves requests for anything that a woman feels would help her become fulfilled and joyful to her mind, body and soul during her fight.

GENAROSITY Recipient Nomination Form

Name *

First

Last *

Last

Age

Email *

Phone *

Address *

Address

City

State/Province

Zip/Postal

Country

Symptoms / Diagnosis / Dates / Summary *

Future Treatment Plans

Purpose for Donation Funds (if known)

ie. wig, graduation party, weekend trip, new clothes, etc.

Husband / Kids / Family

Please include names and ages where appropriate.

Workplace

Hobbies or Special Interests

Caring Bridge or Facebook Website URL

Please tell us briefly why you are nominating this person. Why do you think they are deserving?

Attach Images

Maximum upload size: 268.44MB

Please try to only upload images that are under 1 MB in size. If possible, please try to name the files with who is in them (i.e. Mary_with_sons_Jack_and_Jon.jpg)

Nominated By