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
First & Last Name of Parent or Guardian
City, State, Zip Code
First & Last Name of Child Affected by Cancer
Where has your child received treatment?
St. Jude Affiliate Clinic at Saint Francis Children's Hospital, Tulsa OK
OU Children's Hospital, OKC OK
St. Jude Children's Hospital, Memphis TN
Child's Treatment Status
Fighter - Still on Active Treatment
Survivor - Finished Cancer Treatment
Angel - Always in Our Hearts
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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This form was created inside of Oklahoma Family Network.