• Compassion Can't Wait

    For Single Parent Families of Children with Life Threatening Illnesses

    We are pleased to assist your family by paying for urgent everyday needs during your child’s treatment and when all other resources are exhausted. Kindly have your child’s social worker fill out this form and click "Submit" to send the application electronically


    Rev 07/2016

  • Assistance Currently Received by the Family

    Dear social worker, please tell us to what other agency you have reached out to for assistance. We are a small California foundation with a big mission—and an even bigger heart. But we know that each community has their specific support organization.


    We are aware that each hospital community has specific support organizations, therefore, please put a checkmark next to the resources for which you already applied:

     


  • Accepted file types: pdf, jpg, gif, png.
  • Or fax to (310) 276-0244



  • We ask permission to use your information in an effort to provide service and financial assistance for your family. This information may, with discretion, be shared on your behalf with service providers, utilities, landlords, etc. to aid and preserve your family’s financial welfare. We may also use information in order to promote the charitable goals of the Compassion Can't Wait foundation. If you don't wish to disclose information, this will not affect compassioncantwait.org's willingness to assist your family.

     

  • By checking the box I agree that information I have entered above is completed and will be the electronic representation of my signature.

  • *If parent/guardian has Limited English Proficiency, please add interpreter’s signature attesting to interpretation in parent’s home language.