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Apply for Assistance 



Please use this form to contact the Daniel T. Liss Memorial Fund in regards to applying for assistance or a donation.  We are a small fund, run purely off of volunteers and love, so we ask for your patience in a response.  



Please fully complete the form below, with the following information, in order for your application to be considered completed.



MUST INCLUDE:

  • All applicants must be children, who are a cancer patient, a child with a parent that is a cancer patient or a sibling of a cancer patient.  
  • Your name and relationship to applicant
  • Your email address and preferably a phone number as well
  • A brief medical history of the patient (date of diagnosis, current condition, where they are being treated, etc.)
  • Age and interests of the child(ren)
  • Location of the family you are applying for



Your details were sent successfully!

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