Gift Assistance Application
Families who have had a child diagnosed with cancer that live or received treatment in Oklahoma are eligible to request assistance for those who are 21 or under living in the home. If there is a special circumstance, please contact us and we will see if we can help.

To keep everyone safe by limiting contact, assistance this year will be $50/child delivered as an electronic gift card to your email. Funds are limited, so please do not apply if you are receiving gift assistance from another organization. Applications for assistance must be received by November 30th.

Amy White, Pediatric Oncology Coordinator
Oklahoma Family Network
Email address *
First & Last Name of Parent or Guardian *
Mailing Address *
City, State, Zip Code *
Phone Number *
First & Last Name of Child Affected by Cancer *
Where has your child received treatment? *
Child's Treatment Status *
How many children are in your home, 21 and younger? *
Please list their names and ages: *
Which Electronic Gift Card would you prefer? *
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