Get ready to apply
CURE Childhood Cancer
Counseling Program
What you get
Counseling Program for your child and your family. 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
CURE Counseling Application FormDate of ApplicationParent/Caregiver 1 Name — First NameParent/Caregiver 1 Name — Last NameRelationship to PatientEmailPhone (Cell)AddressParent/Caregiver 2 NameParent/Caregiver 2 Relationship to PatientParent/Caregiver 2 EmailParent/Caregiver 2 Phone (Cell)Name of Child Diagnosed With Cancer/LCH/HLH/Aplastic AnemiaChild's Date of BirthDiagnosisDate of DiagnosisHospitalMy Child IsName of Family Members For Whom You Are Seeking Therapy. (click + to add more family members)How do you prefer seeing your counselorHow did you hear about CURE's counseling programAny information you are looking for in a new therapist (i.e. specific specialties, religion, ethnicity, etc.) and any additional information you would like for us to know as we find options for you and your familyI Consent (Please check box giving consent)
After you send
CURE states it will contact the family; no response timetable is published.
