We have received your Spierings Cancer Foundation Family Grant Application patient and family data. There is one more step to complete your application: Download and complete the Physician Confirmation form and send it to us.

As a reminder, Spierings Cancer Foundation Family Grants are accepted during our two application periods only. January 1st though April 30th & July 1st through October 31st.

In order to be eligible for the Spierings Cancer Foundation Family Grant:

• You have not received a Spierings Cancer Foundation Family Grant in the past.
• Your permanent residence is in one of the following counties: Outagamie, Brown, Calumet, Winnebago or Waupaca.
• You have mailed your completed doctor's confirmation form with signature.

When we have received all of your documents your application will go under review and someone from our Grant Committee will contact you.

Thank you for your application. We look forward to meeting you and your family.

Sincerely,