Hope Grant

Application

The mission of Little Pink Ribbon Girl is to assist in the financial strain cancer brings to individuals living in Stark County, Ohio. The vision of Little Pink Ribbon Girl is to honor Angie Conley and the many other strong individuals who are currently facing the challenges that cancer brings through financial grants.

Little Pink Ribbon Girl Foundation grant recipients are those who are going through any type of cancer diagnosis and must show a need for financial assistance.

We invite those in the Stark County area to apply for our grants.

Spring 2025 applications will be accepted from April 1 – May 10th.

Please Tell Us About the Applicant

Name

First Name

Last Name

Address (Include Apt. or Bldg. #)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Marital Status

Married

Single

Divorced/Separated

Widowed

Other

Number of Dependents (Including Patient)

Number of People Living With Patient

Number of People Living With Patient UNDER 18

Annual Household Taxable Income

Prior year tax return gross or current year estimated.

Month & Year of Cancer Diagnosis

Type of Cancer and Stage if Known

Facility Where You Are Receiving Care

How Has Your Cancer Treatment Affected Your Finances and Created A Hardship? (Please be as detailed as possible)

e.g. - leave of absense from work, reduced work hours, uncovered medication costs, travel expenses, etc.

Please Share Your Cancer Diagnosis Story With Us.

How Did You Learn About Little Pink Ribbon Girl Foundation?

Have You Received a Hope Grant In The Past? If So, What Year?

Have You Received Any Assistance From Any Other Organizations To Assist With Hardships?

Any Additional Information You Would Like to Share With Us?

Name of the Individual Filling Out This Application IF NOT the Recipient?

Would you be willing to be photographed using visual content to attract and engage supporters to continue on our mission? (This does not impact our decision making process, it just informs us when delivering the grant.)

Yes

All spring grant awards will be notified by the first week of June.