Kellie’s Krew is dedicated to helping patients with ACC, Head and Neck Cancer, as well as Osteosarcoma with our Gift Card Program given to any patient with qualifying diagnosis and our Patient Assistance Grant for those whom have a long term recurrent diagnosis. If you would like to download and print this application, please click HERE

Kellie’s Krew, Inc. strives to help as many applicants as possible from the funds raised through our events and donors.

Please be aware of the following guidelines when applying for assistance from Kellie’s Krew:

• ELIGIBILITY FOR ASSISTANCE IS LIMITED TO PATIENTS WITH ACC, HEAD & NECK CANCERS, AND OSTEOSARCOMA. PRIORITY IS GIVEN TO PATIENTS WITH METASTASIZATION.
• All applicants must be undergoing treatment at the time of and during the month of requested assistance.
• Applications must be submitted on or before the 15th of each month to be considered for assistance in the following month.
• Each applicant is limited to one (1) Patient Assistance Grant. You may reapply for the Gift Card Program.
• All applicants for long term patient assistance must have a long term recurrent diagnosis and undergoing treatment at the time of requested assistance.
• Applications must be submitted on or before the 15th of each month to be considered for assistance in the following month.
• Applicants are limited to one (1) long term patient assistance grant per lifetime.
• The Kellie’s Krew Patient Assistance Program is limited to $5,000 and will be provided by certified check, as well as reported to the IRS on a form 1099.
• The Kellie’s Krew Board of Director’s reserves the right to deny applications based upon funds availability, or other circumstances that may arise.
• Kellie’s Krew Inc., does not discriminate against any person on the basis of race, color, national origin, disability, gender, gender identity, sexual orientation, religious preference, or age in its programs, services, assistance programs and activities.
• We value your privacy, therefore applicant information and medical history will only be shared with the Kellie’s Krew Board of Directors unless prior consent is obtained.