Apply - The Daisy Fund

The Daisy Fund was established to support families that have a family member with cancer or other catastrophic or terminal illness. Our primary mission is to help families with their financial needs during these challenging times when they are faced with the heart-wrenching dilemma of paying to keep the lights on or paying to keep their loved one alive.

We understand that when someone is diagnosed with a serious illness, not only is the individual affected, but potentially the entire family is impacted in one way or another.

Often times the primary caregiver must stop working to care for their afflicted loved one leading to reduction or termination in income. Depending on their employment situation, this interruption in wages may result in unpaid housing costs, including rent, mortgage, utilities, and such; medical and pharmacy charges not covered by insurance; and/or fees incurred for travel to and from treatment.

You may apply for yourself or on behalf of someone else.

The application will be reviewed and verified by The Daisy Fund Board of Trustees.

The Daisy Fund reserves the right to assist individuals and families in the following Pennsylvania counties ONLY: Franklin, Fulton, Huntingdon, Mifflin, Juniata, Perry, Cumberland, Adams, York, Dauphin, Lancaster and Lebanon

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Apply for Assistance

Application for Assistance

Name of Individual Completing Application*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Email*
Applying on behalf of (if different from above)
Name
First Last
Address
Street Address Address Line 2 City State ZIP Code
Phone
The Daisy Fund was established to help individuals and their families who are suffering from cancer with non-medical expenses such as gas money to get to appointments and lodging and meals while at appointments. The Daisy Fund Board may also consider other catastrophic illness needs on a case by case basis. Please write a brief paragraph stating your needs or the needs of the person and family for which you are applying.*
Applications will be reviewed on a monthly basis. All applicants will be notified of the Board’s decision
Signature*
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