Get ready to apply
Circle of Care
Art from the Heart
What you get
Art from the Heart. The activities and costs aren't published. Ask. 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
Before you start, check you fit
- Exact participant, date, capacity, and access rules are not fully published.
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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
Information About The PatientToday's DatePatient's First NamePatient's Last NamePatient's Birth DatePatient's AddressPatient's PhonePatient's EmailType of CancerDate of DiagnosisOncologist's NameTreatment CenterIs the patient currently in active treatment for cancerIs the patient a Connecticut residentPatient's EthnicityInformation About The FamilyWhat is your relationship to the patientG1: First NameG1: Last NameG1: AddressG1: TelephoneG1: EmailPatient's Siblings: Names and AgesPlease explain what a room makeover would do for your child/familyUse your imagination! What does a "dream room" look like to youRelease and Statement of ConfidentialityG1: Parent/Guardian 1 Electronic SignatureSocial Worker or Healthcare Professional Electronic Signature
After you send
Email programs@thecircleofcare.org with application questions or to follow up if no acknowledgment arrives.