Please note the following before starting your application:

WHO WE PROVIDE FINANCIAL ASSISTANCE TO:

Our foundation’s focus: We are primarily focused on acute leukemia (AML/ALL) in the adolescent and young adult (AYA) population, defined by the National Cancer Institute as ages 15-39, in the U.S. Patients with other types of leukemia or in other age groups may apply, but may qualify for a lower amount as explained below. All awards are subject to approval of our Board of Directors and availability of funds.  

We have also compiled a comprehensize list of other possible sources of financial support at https://jacksoncopeland.org/resources/.

Important note about the patient’s diagnosis: Our foundation’s charter and funding are strictly dedicated to fighting leukemia and related blood cancers. As a non-profit, we are legally and ethically bound to spend our donor, sponsor, and grant funds solely on our stated mission in support of blood cancer patients. We are unable to authorize expenditures for causes that are “off mission”, regardless of how deserving they are. For this reason, if the patient has been diagnosed with any other type of illness (such as breast cancer, skin cancer, or blastoma), your application will likely be denied. 

Non-U.S. Applicants: As a registered public charity in the U.S., IRS regulations prohibit us from sending funds outside the U.S. and its territories. Regrettably, we are unable to provide financial assitance to applicants from other countries. 

WHAT TO EXPECT:

We will normally process your application and respond via email in 5-10 business days. Please keep an eye on your email for a response. Once approved for a grant, we will send you a disbursement agreement to be completed online. Funds are disbursed via an electronic gift card (that can be used on its own, or added to your Google or Apple Wallet), or via PayPal.

Acute (i.e. AML/ALL) AYA patients may qualify for $250, $500, $750, or $1,000 based on a scoring rubric that takes into account the patient and family’s:

• Work/Income Situation
• Responsibility for Dependents/Childcare
• Diagnosis/Prognosis and Treatment Intensity
• Financial Position/Urgency
• Insurance
• Support Network

Non-acute (i.e. CML/CLL) and/or non-AYA patients are limited to an award of $100. 

Please Note: The application will likely take 15-30 minutes to complete, and this form requires a Google/Gmail account (or an account that is linked to a Google account, common with some Yahoo addresses) in order to ensure HIPAA compliance (but it does not have to be your primary email for communication purposes).

If you do not already have a Google/Gmail account, you can create one quite easily, for free, here. It’s best to create the account (if needed) before starting the application.