All applications are kept confidential, to the best of our abilities. We will acknowledge all requests. We cannot meet every request; however, some assistance is generally available. Our grants are need based for the children and their families. These grants are designed to offset the hidden cost in their battle with cancer. We understand each request is unique and we will take that into consideration. The form below will give us a better understanding of how we can best help. Financial Assistance will be awarded in the form of a grant and will expire 6 months after the issue date unless the board deems it a necessary circumstance. All payouts will be issued to the creditor or lean holder.
Dustin’s Promise reserves all rights and the applicant hereby grants Dustin’s Promise permission to share the information in this form to third-parties (Doctor, Nurse, Social Worker, other charities, etc.). Currently, financial assistance is only granted to citizens in the Greater Shoals Area or citizens from the area who have recently moved for treatment. (Colbert, Franklin, Lauderdale Counties).
To Apply for financial assistance the following documents may be required:
A copy of recent pay stub(s) AND (2) months of bank statement(s) – checking and savings; all pages.
A copy of the applicant or guardian(s) most recent W-2 AND Tax Return(s).
Copies of bills (utility bills, mortgage coupon, car repair estimate, etc) the family needs help with.
A clear digital photo (no photo copies or faxed copies) of the applicant. If the patient is a guardian then a photo of the guardian(s) with the child(ren) is required.
A letter from the treating physician and/or social worker on his/her letterhead stating the type of cancer diagnosed, the treatment prescribed and a statement that the patient is currently in active treatment.
A letter from the applicant or guardian in their own words describing the hardship caused by the cancer diagnosis.
You may also attach any pertinent information so we can better assist.