Get ready to apply
Cancer Services for Northeast Indiana
Kids and Family Support
What you get
Age-appropriate practical and emotional support for you and your child during cancer. Ask whether requests are open.
- Who starts it
- You
- How it’s sent
- Online, on their website
- Your time
- About 30 minutes
- Last checked
- Aug 27, 2026
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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
Person with cancer and contact informationName(Required)GenderDate of BirthAddress(Required)City(Required)State(Required)Zip(Required)County(Required)EmailPrimary Phone(Required)Secondary PhonePrimary Phone Type(Required)Secondary Phone TypeName of Parent or Guardian if person with cancer is under 18Cancer Diagnosis(Required)Date of DiagnosisPerson completing the form for someone elseYour NameRelationship to the Person with CancerPhoneEmailIs the person with cancer aware that Cancer Services will be contacting themKids and Family Support requestTell us more about your situation and needs
After you send
Expect a call within one to two business days; if no call arrives, contact Cancer Services and ask for a Client Advocate. If you have not heard back by then, write and ask.
