Get ready to apply
HEADstrong Foundation
Nick's House Boston
What you get
A place to stay during cancer treatment. Ask about room availability and the cost. Open now.
- Who starts it
- You
- How it’s sent
- Online, on their website
- Your time
- An hour or so
- Last checked
- Aug 27, 2026
Before you start, check you fit
- Nick's House is not a healthcare facility and cannot be used to administer medical therapies, palliative care, or hospice care.
- Medical treatment and hospice care cannot take place in the lodging.
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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
Location and eligibility certificationNick's House location you are applying forI certify that I meet all the requirements below for staying at Nick's House, PhiladelphiaI certify that I meet all the requirements below for staying at Nick's House, BostonPatient contact and stay informationPatient NameEmailPermanent AddressPrimary PhoneSecondary PhoneDate of BirthSocial Security #GenderAnnual Household IncomeEmployerOccupationEmergency Contact Name (Different than Caregiver)Emergency Contact Relationship with PatientEmergency Contact Primary PhoneEmergency Contact Secondary PhoneArrival Date at Nick's HouseDeparture Date from Nick's HouseCancer DiagnosisDate of DiagnosisDo you have health insuranceDo you have a prescription drug planDo you have medicareDo you have Medicaid (Title 19)Show the rest of the form (5 more sections)
Treating physician and patient referenceHospital Where Receiving TreatmentTreating Physician NamePhysician AddressPhysician Phone #Physician EmailSocial WorkerSocial Worker Phone NumberSocial Worker EmailAuthorization to ContactPatient Non-related Reference (can be social worker, doctor, employer, etc.)Patient Non-related Reference PhonePatient Non-related Reference Relationship with GuestPatient Tshirt SizeCaregiver informationCaregivers NameCaregiver Birth dateCaregiver Primary PhoneCaregiver Relationship with PatientCaregiver AddressCaregiver EmailCaregiver Non-related Reference (can be social worker, doctor, employer, etc.)Caregiver Non-related Reference PhoneCaregiver Non-related Reference Relationship with CaregiverCaregiver Tshirt SizeAdditional guestsDo you have more guests then just the caregiver staying with youGuest 1 NameGuest 1 Birth DateGuest 1 AddressGuest 1 EmailDo you have more guests staying with youGuest 2 NameGuest 2 Birth DateGuest 2 AddressGuest 2 EmailAdditional informationWho we should receive phone communications regarding your stay with usWill patient or any guest require special accommodationsIf "Yes" please explainPlease explain how housing services from the HEADstrong Foundation will assist with financial hardship caused by your medical conditionElectronic certificationBy clicking below, you are providing consent for us to reach out to you for a background checkI agree to the terms and conditions as stated belowThe undersigned certifies to the HEADstrong Foundation that he/she meets the eligibility requirements of the Nick’s House Residential Services Program, as described in this Application, and that all the information provide in or with this Application is true and correct
After you send
Complete every adult background-check link sent after submission. Email info@headstrong.org if no response arrives within 24–48 hours. If you have not heard back by then, write and ask.
