Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
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Christmas Without Cancer

Year-Round Cancer Assistance

What you get

Gas, groceries, medical bills, medication, mortgage or rent. The amount isn't published. Ask. Open now.

Who starts it
You, with a letter from your doctor
How it’s sent
Email to christmaswithoutcancer@gmail.com, or by post
Your time
An hour or so, plus waiting for the letter
Last checked
Aug 27, 2026

Before you start, check you fit

  • For requests above $500, you need income, tax and bank documents.
  • Allow at least two to four weeks for review.
  • Assistance is discretionary and depends on a changing monthly budget.

  1. Ask your doctor for the letterStart here. This is the part that takes the longest.

    Christmas Without Cancer needs 2 things from your doctor. It has to cover one thing. Copy this message, or say it in person at the next visit.

    Hi [doctor’s name],

We’d like to apply to Christmas Without Cancer’s Year-Round Cancer Assistance. They offer gas, groceries, medical bills, medication, mortgage or rent, and they are taking applications now.

They need 2 things from you: a signature on the form and a letter. The letter has to cover our child is currently receiving active cancer treatment. Their form and instructions are here: https://christmaswithoutcancer.org/application/

Could you write that when you have a chance? I’ll bring the printed form to our next visit, or I can email it. Thank you for everything you do for us.

[your name] · [phone]
    Copying is the only thing this page does with your text. Nothing is saved.

  2. Fill in their formPrint it, or fill it in on screen if the PDF allows.

    Open the application PDF ↗ Checked Aug 27, 2026

    What the form asks for

    Personal and medical information
    Application DateName of PatientName of Legal Guardian (if submitting on behalf of minor or ward)Address / City / State / Zip CodePhone NumberEmail AddressDate of BirthDriver’s License / State I.D. #SSNGender*US Citizen?*Military Veteran?*Marital Status*Race / Ethnicity*Number of Household MembersNames and Ages of all Household Members (including Patient)DiagnosisDate of DiagnosisDate of RelapseHospital / Facility of TreatmentName of Physician / Nurse PractitionerName of Social WorkerOther (specify)
    Insurance and financial information
    Do you have health insuranceIf not covered, have you applied for MedicaidDo you pay for your health insurance monthlyIf yes, amount $Types of insurance (check all that apply)Other (please specify)Current Employment StatusIf unemployed, what was your last date workedAre you receiving unemployment benefitsIf disabled, are you receiving disabilityIf yes, what type of disability (i.e. short-term, long-term, social security, private policy, etc.)Monthly amountAre you or other household members required to file a federal tax returnAre you claimed as a dependent on any federal tax returnHow many people live in your household and are claimed as dependents on your tax returnWhat was your household gross income in the last calendar year
    Show the rest of the form (2 more sections)
    Requested assistance and additional information
    How did you hear about Christmas Without CancerAre you receiving assistance from other nonprofits or agenciesIf yes, please let us know who they are and how they have assisted you or your familyOther gift card requests (be specific)Do you have a bank accountIf not, please let us know what facility you will use to cash a checkDo you have transportation to/from treatment, etcIf not, please let us know what transportation service you use (Pace, Family/Friends, Uber, Lyft, etc.)Are you past due on any household bills (mortgage, rent, car, tuition, utilities, etc.)If yes, please let us know (please note proof may be requested)Additional patient information
    Approvals, declaration, and releases
    EACH BOX ABOVE AND INITIAL HERE ACKNOWLEDGING THAT YOU HAVE READ AND UNDERSTAND THE ABOVE REQUIREMENTSPatient Signature or Legal Guardian SignatureHealthcare Provider SignatureApplicant Declaration and Release Form - Printed NameApplicant Declaration and Release Form - SignatureIf the person is under the age of 18: I, [name] am the parent/guardian of the individual named aboveWaiver and Release of Liability - Printed NameWaiver and Release of Liability - Signature and Date

    Have ready

    • Clear copy of the patient's valid Illinois driver's license or state ID, or the parent/legal guardian's valid Illinois ID when applying for a child or ward.
    • Letters of Guardianship when a guardian applies for a ward.
    • For a financial grant request exceeding $500: two most recent pay stubs and/or Social Security and pension statements, the last two federal tax returns, and the previous two months of bank statements.

  3. Email your application and the letter togetherTo christmaswithoutcancer@gmail.com. Or post it to the address on the form.

    • Email one complete PDF to christmaswithoutcancer@gmail.com, fax the complete packet to 708-658-1536, or mail it to 15418 S. Harlem Ave., Orland Park, IL 60462-4333.
    • Do not email images, screenshots, or separate attachments.

    Email: christmaswithoutcancer@gmail.com

    Fax: 708-658-1536

    Subject: Year-Round Cancer Assistance application, [child’s name]

Hello,

Attached are our completed application and the letter from [doctor’s name] at [hospital]. Please let me know that it arrived and if anything is missing.

Thank you,
[your name] · [phone]

After you send

Allow at least two to four weeks for processing before requesting a status update through the published email. If you have not heard back by then, write and ask.

Full record, as published