HEADstrong Foundation

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Financial Assistance Application

Please note - Here at HEADstrong, we get so many requests to help on a daily basis and while we wish we could financially help each and every one of them we are not able. For this reason, we have limited our financial aid only to those battling a blood cancer such as lymphoma or leukemia who are undergoing active treatments.

For those battling another type of cancer, we offer the option to receive a comfort kit, start a relief fund, or join our HEADtoHEAD peer support program.

Funding for blood cancer patients, applications are reviewed and awarded on a monthly based on availability of funds. Because of the large number of applications, only those awarded funding will be notified. 

Keep fighting!

For questions, please email support@headstrong.org

INCOMPLETE APPLICATIONS WILL NOT BE CONSIDERED

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We are sorry but you no longer qualify for financial assistance from us.

Because of the great need for assistance, our financial assistance program is a one time gift to those in need. Because you already received funding from us, you are no longer eligible. Thanks for understanding.
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We're sorry but you do not qualify for our financial aid program

Even though you aren't eligible for our financial aid, we still want to be able to help. We have 2 options you are able to sign up for. Please visit the corresponding link to fill out the form. ______________________________________________________________________________________________________________ COMFORT KIT - includes some items to help you as you go through your treatment. Link Below. https://secure.lglforms.com/form_engine/s/jsTr9XWoJUJBvX0A1fr0XQ ______________________________________________________________________________________________________________ HEADtoHEAD Peer Support - Would you like to talk to someone who's been in your shoes? We have a program where we are able to set you up with someone who understands where you've been and is willing to talk, listen and be a support. Email support@headstrong.org with your name, contact info and the type of cancer you are battling.
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Ex. Chemo, Radiation, Transplant, CAR-T Therapy

We're sorry but you do not qualify for our financial aid program

Because of the large number of applications received, we limit our financial aid to those going through active cancer treatment. Even though you aren't eligible for our financial aid, we still want to be able to help. We have 2 options you are able to sign up for. Please visit the corresponding link to fill out the form. ______________________________________________________________________________________________________________ COMFORT KIT - includes some items to help you as you go through your treatment. Link Below. https://secure.lglforms.com/form_engine/s/jsTr9XWoJUJBvX0A1fr0XQ ______________________________________________________________________________________________________________ HEADtoHEAD Peer Support - Would you like to talk to someone who's been in your shoes? We have a program where we are able to set you up with someone who understands where you've been and is willing to talk, listen and be a support. Email support@headstrong.org with your name, contact info and the type of cancer you are battling.
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Contact Information

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Do not include dashes. Complete 9 digit SS# is needed.
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Enter whole numbers only, do not include $, commas or spaces - This is to be the total yearly household income.
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Please upload a document to verify your Annual Household Income. This can be a 1040, paystub or current tax return.
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Treating Physician Information

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By clicking this button, you authorize HEADstrong Foundation to contact your medical team to validate this application.
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Electronic Certification

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The undersigned certifies to HF that he/she/they meets the eligibility requirements of the Fighter/Relief Program, as described in this Application, and that all the information provide in or with this Application is true and correct.