A NON PROFIT CHARITY FEDERAL 501(C)3

Have a Heart Children's Cancer Society, user friendly Request Application for Financial Assistance is made easy in order to expedite the process. 

This was designed to simplify the steps and allow social workers to fax the completed application directly to our corporate office for processing.  To submit the financial assistance application, please fax it directly to 631 223-3964. All applications must be filled out completely in order to be processed.

If you have any questions, please call 631 470-1198. 

CLICK HERE for the application - you will need Adobe Acrobat Reader to open the application. If you do not have the FREE Adobe Acrobat Reader click on the Get Reader box below.