Congratulations, Jon! Your vision and resourcefulness have opened the Jack and Jill Late Stage Cancer Foundation with a mission and structure for success. What you have started is the right thing to do, and it is good to also see you are doing it well. Those of us who have worked to save and enrich lives wish you the very best.
Robert S. Bolan, Ph.D.
Former CEO, American Diabetes Association, Former Chair of the Board, Medic Alert Foundation International
Referral Process and Eligibility Requirements
WOW! Experience program referral candidates must meet all eligibility requirements below before the oncologist can submit the referral.
If you are not a current Oncology Coaltion Partner, please complete the Coalition Partner application form and contact Heidi Cohen at 404-279-5211 (ext 2).
All referral candidates must:
- Be referred directly from their treating oncologists
- Have late stage limited life expectancy cancer
- Have at least one (1) child age between the ages of three (3) and eighteen (18) - Only one child must meet the minimum age requirement
- Have a life expectancy more than two (2) months
- Have not participated in an any adult dream, wish, or any other similar program
Referral Forms
After confirming all eligibility requirements have been met, please download and print both the Referral Form Part I and Referral Form Part II via the links below. The treating oncologist should fax the completed forms to 404-920-2139. If you have questions regarding the referral process or forms, please call Heidi Cohen at 404-279-5211 (ext 2).