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

Childhood Cancer Lantern
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The Mya Lin Terry Foundation

Pediatric Cancer Monetary Grants

What you get

Help with transport, medical costs, utilities, rent, childcare, food, or a family trip. The amount isn't published. Ask. Open now, but funds are limited, so ask early.

Who starts it
You, with a document from your doctor
How it’s sent
Email to kellylynnterry@msn.com
Your time
About 30 minutes, plus waiting for the document
Last checked
Aug 27, 2026

Before you start, check you fit

  • Diagnosis must have been within the past 24 months; a bill-specific request needs an invoice.
  • Publicity consent is required to process the request; the separate photo is optional.
  • Current or recent New Jersey residence required; recent is not defined.

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

    The Mya Lin Terry Foundation needs a signed confirmation of the diagnosis from your doctor. Copy this message, or say it in person at the next visit.

    Hi [doctor’s name],

We’d like to apply to The Mya Lin Terry Foundation’s Pediatric Cancer Monetary Grants. They offer help with transport, medical costs, utilities, rent, childcare, food, or a family trip, and they are taking applications now while funds last.

They need a signed confirmation of the diagnosis from you. Their form and instructions are here: https://www.themyalinterryfoundation.org/pay-it-forward

Could you do 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

    Patient, parent, and medical information
    DateONE: INITIAL APPLICATION / SUPPLEMENTAL APPLICATIONPatient First Name / Last NamePatient Street Address / City / State / ZipHome Phone / Cell PhoneEmailWebsite/CaringBridge/Facebook/GoFundMe SiteDOBMale/Female (please circle one)SIBLING(S) and AGESSPECIAL INTERESTS OF CHILDMother's and Father's names, addresses if different, phones, and emailsDiagnosisDate of DiagnosisCurrently Undergoing Active Treatment: Yes/NoDate of Last Active TreatmentDoctor Name / Primary Hospital / Alternate HospitalAny additional information you would like to provideContact Information of medical/health care provider or social worker: Name / Hospital/Facility / Phone Number / Email
    Current need, requested assistance, and other resources
    To help understand the big picture, please give a detailed description of daily situation, i.e. job/work, children, living circumstances, family situation, insurance, etcASSISTANCE REQUESTED / COST / PAYEE/VENDOR / INVOICE INCLUDED (yes/no) — please prioritize your listPlease disclose any other resources or assistance applied for/received/or receiving: Organization Name / Date(s) Received / Contact Name / Phone Number / Email
    Acknowledgement and consent signatures
    I certify, promise, and affirm that the information is true ... and I will utilize such grant for the specified intended purposesWe hereby consent to the sharing of my info with TMLTF Sister Charities: Yes / No (initial)Dated / Name / Address / Phone / SignatureIF UNDER 18, PARENT OR GUARDIAN MUST ALSO SIGN BELOW: Name / Address / Phone / Signature / Relationship to Minor

    Have ready

    • Completed, signed, and dated January 2025 grant application.
    • Invoice for each specific bill requested.
    • Completed, signed, and dated Consent, Release, and Waiver.

  3. Email your application and the document togetherTo kellylynnterry@msn.com.

    • Email the completed, signed application and consent form with the signed physician diagnosis note and applicable invoices to kellylynnterry@msn.com.

    Email: kellylynnterry@msn.com

    Subject: Pediatric Cancer Monetary Grants application, [child’s name]

Hello,

Attached are our completed application and the document 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 three to four weeks for receipt, review, and processing. Keep a copy of the consent form and the complete submitted packet. If you have not heard back by then, write and ask.

Full record, as published