Submit Grant Request

Patient Grant Request Form

ArmorUp for LIFE has 5 pillars: Diet, Exercise, Lifestyle, Spiritual and Financial Fitness.

Our mission to to help you ArmorUp during and after your treatment in any of the 5 ways. I’ve been through this struggle and I know it is not easy. I, along with our amazing ArmorUp for LIFE warrior volunteers, know that the struggle doesn’t end after the last drip of chemo and yes you do still need financial help or donations to get back up .

Our goal with this form is to find out how we can help YOU ArmorUp for your LIFE.

Based on your needs and our funding we will help in the following ways:

• Diet- Do you need (grocery donations or gift cards )
• Exercise- Do you need fitness gear, sneakers, a fitness tracker, socks, tanks, treadmill, or help funding an exercise trainer to get you strong again?
• Lifestyle- Do you need medical massages or other treatments that can lower the stress in your life? Do you have a memory you want to go make and can’t afford it ?
• Spiritual- Do you need someone to help you spiritually?
• Financial/Professional – Are your finances a mess now? Do you need a connection to a financial planner to help you get back up? Do you need a professional contact to help you get back to work?

 

Your Name (required)

Your Email (required)

Contact Number

Your Address

Type of Cancer

Status

Treatment Facility

Length of Stay

Please list what we can help. We are a new organization and will do our best to help in as many ways as we can.

Please list if you have a Caring Bridge/GoFundMePage to read more about your story and how we can help. Please list below.

Does ArmorUp for LIFE have permission to use your pictures to post on social media to ask others for help if we need more funding to help your cause?
Yes No