2026 Application

    • 1

      Application Information

    • 2

      Diagnosis and Treatment

    • 3

      Hospital and Physician Information

    • 4

      Financial Information

    • 5

      Photo Consent and Release

    • 6

      Referral Information

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    Application Information

    Applicant Information

    Is the Applicant 18 - 30 yrs old?

    Applicant Gender

    Applicant's T-shirt size

    State Must be a resident in the state of Wisconsin. This is new for 2026. For the past number of years, donations have come exclusively from the state of Wisconsin, and the number of applications we have received exceeded the number of people we’ve been able to help.

    0%

    Diagnosis and Treatment

    Is the applicant's diagnosis confirmed?

    Is the applicant currently receiving treatment?

    What was last type of treatment that the applicant received?

    What was the intent of the treatment that the applicant last received?


    20%

    Hospital and Physician Information

    40%

    Financial Information

    Is the applicant in a state of financial need having either lost their job, experienced sustained major wage losses, or have limited employment opportunities?

    Does the applicant have health insurance?

    Is the applicant currently employed?

    60%

    Photo Consent and Release

    80%

    Referral Information

    Relationship to Applicant

    How did you hear about L.I.F.E.?

    100%

    L.I.F.E. is a 501(c)(3) non-profit organization dedicated to cancer survivorship by providing assistance to young adults who are fighting cancer and in financial need. This is accomplished through our cancer survivor grant program.  The amount of each grant depends on the availability of funds and resources, but is approximately $1,000.  Since 2003, we have proudly awarded over $300,000 towards financial assistance and research.

    This L.I.F.E. Survivor Grant application will be open from March 20, 2026 (the first day of Spring) through July 1, 2026.  Recipients will be announced on or around July 17, 2026 (Eric’s birthday). All candidates must meet the following criteria, and be able to provide the information below.  If you are unsure about something, please contact us with any specific questions.

    • Must be a resident in the state of Wisconsin. This is new for 2026. For the past number of years, donations have come exclusively from the state of Wisconsin, and the number of applications we have received exceeded the number of people we’ve been able to help.
    • The applicant must be between the ages of 18 and 30 years old.
    • The applicant must be a U.S. citizen and have received treatment in the U.S.
    • The applicant must be in a state of financial need having either lost their job, experienced sustained major wage losses, or have limited employment opportunities.
    • The applicant should be able to explain how their cancer has affected their current financial situation.
    • The applicant must complete a Medical History Verification Form that has been signed by a licensed practitioner by whom you were treated.
    • The applicant must agree to sign our Photo and Consent Release Form and and email it back to us at life@givetolife.org. If an applicant is selected for one of our grants, we do ask that they agree to have their name, photo, and a brief story published onto our website and/or social media. The ability to tell their story helps us fundraise for future patients and keep our mission alive.

    L.I.F.E. will uphold the privacy of each applicant, but we do ask that if an applicant is selected for the grant, that they also agree to have their name, photo, and brief story published onto our website and/or social media.  All other information gathered through our application process is kept secure and confidential.