Patient Application

 
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Before completing the application, please note:

Pinky Swear processes applications monthly.

  • Pinky Swear supports children with a cancer diagnosis in active treatment for cancer only.
  • Meeting the criteria of this application does not guarantee approval.
  • Applications are due the last day of the month, and reviewed and distributed the following month. For example, if you apply in January, your request will be reviewed in February.
  • The primary contact and Pediatric Oncology Social Worker listed will be notified by email. 
  • Grants that are approved will be dispersed the last week of each month.
  • Please remind your social worker to sign a release of information so they may verify your request.
  • Only one bill is allowed per application, and one application is allowed per month.
  • Please do not submit multiple applications within the month.

To complete the application you will need:

  • Your Pediatric Oncology Social Worker's contact information. Please do not submit the application if you do not have your social worker's information. 

Applications without the following information may not be reviewed:

  • Pediatric Oncology Social Worker’s email and phone number.

Has your child been diagnosed with cancer in the last 6 months? 

Pinky Swear reserves the right to change these guidelines at any time without notice, and to apply these guidelines at its reasonable discretion. If you have any questions, please contact Program at 952-225-1665 or email.