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AYA Foundation San Antonio
AYA Support Network Navigation
What you get
Community-partner referrals, and needs assessment. Open now.
- Who starts it
- You
- How it’s sent
- Online, on their website
- Your time
- About 30 minutes
- Last checked
- Aug 27, 2026
Before you start, check you fit
- Your child is between 15 and 39.
- Partner benefits, response times and capacity are not guaranteed.
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What their form asksA preview, so you can gather things first. Fill it in on their site.
Open their application ↗ Checked Aug 27, 2026What the form asks for
English patient-referral form questionsApplicant Full NameDate of BirthEmailPhone NumberFull Current AddressName of the treating institution (where the patient is receiving care) and notate if a social worker is involved, or let us know how you heard about the AYA FoundationName(s) of your Oncologist(s)If we need to follow up with you, what's the best time of day to callCancer diagnosisAge at diagnosisTreatment phaseMarital Status and Household SizeCurrent Monthly Income of HouseholdCurrent employment/student statusWhat type of support do you need for Basic Needs? Select all that applyPlease tell us more about your Basic NeedsDo you have needs related to Financial HealthPlease tell us more about your Financial Health needsDo you need support for Medical CareTell us more about your Medical Care needs. Do you have any barriers to treatmentDo you have Emotional and Social needs? If so, which resources would be most helpfulTell us more about your Emotional and Social support needsDo you need support for Daily LivingTell us more about your Daily Living needsPriority Ranking Please rank your needs from 1 (most urgent) to 5 (least urgent)Do you have Other needsWhat else would you like us to know or use this to tell us about your other needsWhat assistance or resources, if any, have you received so far? (ie. referrals made by a social worker)Resource Connection ConsentBy entering your full legal name below, you certify that the information provided in this application is true and accurate. You authorize the AYA Foundation to obtain and use your relevant health information—including information from your care team—for the sole purpose of verifying your eligibility for assistance, grants, or resource referrals. You understand that eligibility is based on specific criteria that must be met, that submitting this application does not guarantee approval, and that all information will be handled in accordance with HIPAA privacy regulations. You release the AYA Foundation from any liability arising from the verification process or decisions regarding eligibility or availability of assistance, and you confirm your consent to these terms by entering your full legal nameDate application and consent signed
After you send
No response time is published; use the preferred call time field to guide program follow-up and respond if AYA Foundation contacts you.