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“You have cancer” are the three words that no one wants to hear. We understand that cancer does not just affect the patient but also friends, family & loved ones and we want to help! Mikey’s Miracle Foundation, Inc. provides sustainable programs and support services that improve the quality of life for patients receiving cancer treatment and their families at an affordable amount or no cost at all.

Before applying, please carefully read and consider the guidelines below. A member of our Patient Services & Support team will review your application submission and follow up within 14 business days on next steps. Should you have any questions or concerns regarding the application process, please contact us at info@mikeysmiraclefoundation.org.

GUIDELINES

To ensure our services reach the local community, applicants must reside in the Baltimore Metropolitan area. This enables us to provide our services efficiently and maintain a close connection with our patients and their families.

To ensure our services reach the local community, applicants must reside in the Baltimore Metropolitan area. This enables us to provide our services efficiently and maintain a close connection with our patients and their families.

Applicants must be diagnosed with cancer and be undergoing active treatment at the time of application. This ensures our resources are directed towards those in the midst of their battle against cancer, providing support during this challenging phase of their journey.

The duration of enrollment in the program is one year. This period is designed to provide substantial support throughout a significant portion of the patient’s treatment. Please note that the continuation of services after one year is subject to review and re-application if necessary.

To maintain transparency and fairness in the allocation of our resources, verification of the applicant’s cancer diagnosis from a medical oncologist is mandatory. This ensures that all recipients of our services are genuinely in need.

To maintain transparency and fairness in the allocation of our resources, verification of the applicant’s cancer diagnosis from a medical oncologist is mandatory. This ensures that all recipients of our services are genuinely in need.

Funds provided by our program are disbursed directly to service providers. This policy ensures that the assistance we provide is used for its intended purpose, which is to relieve the financial burden associated with cancer treatment.

Applicants must fill out our patient application form accurately and completely, providing all the necessary information and documentation. Incomplete applications or those with incorrect information will result in delays. Be sure to review your application thoroughly before submitting to ensure a smooth process.

Application

Form

    Name (required)

    Date of Birth (required)

    Address: Mailing Address, City, State and Zip (required)

    Phone Number (required)

    Best Time to Call (required)

    MorningNoonEvening

    Email (required)

    Referral Source (required)

    Type of Illness (required)

    Date of Diagnosis (required)

    Indicate Stage (if known) (required)

    IIIIIIIV

    Other Medical Conditions (required)

    AREAS OF NEED (PLEASE CHECK ALL THAT APPLY) (required)

    Early Detection ScreeningIndividual & Family CounselingPastoral CounselingNutrition Services/Meal PlanningProfessional Cleaning ServicesTransportation Services

    BRIEF SUMMARY OF INTEREST
    (Please provide a one paragraph summary on how you will you and your family can benefit from the foundation. A follow-up interview, phone or in-person, will be required after application submission for additional information)

    UPLOAD YOUR MEDICAL RECORDS HERE