Life List Program Application

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Dear Jack Foundation Life List Program Application

Thank you for your interest in the Life List program. LifeList is a wish-granting program that offers hope and guidance to adolescent and young adult patients who are currently receiving treatment for life-threatening cancer diagnoses. This program gives patients positive experiences to focus on during treatment and also provides the opportunity to connect with a community of AYA patients, survivors, and advocates who have experienced similar journeys.

LifeList applications for Q4 are now closed. Our next application cycle will open on January 1, 2020. To receive information about the LifeList program and updates about the next application cycle, please contact us.


CONTACT US


Do I qualify? LifeList program prerequisites

You may be eligible for the LifeList program if you are a cancer patient between the ages of 18-39, currently receiving active cancer treatment, and meet one of the following criteria:
  • Within one year of primary cancer diagnosis
  • Recently experienced a relapse of a primary cancer or a secondary cancer diagnosis.
  • Enrolled in a clinical trial where standard treatment protocols have proven unsuccessful.
  • A patient that goes above and beyond the patient treatment norm.

  • LifeList Program Guidelines:

  • Your LifeList items can total up to $2000 and include anywhere from 1-4 wishes.
  • You are an active part of the program for a total of 6 months from the date of acceptance. All LifeList wishes must be completed or ordered within those 6 months. Any trips requested should also fall within that time frame. Please be aware of your health status and the reality of being able to fulfill your requests within 6 months.
  • While DJF strives to make wishes come true, we reserve the right to deny a wish or request modifications to one. If DJF has concerns about your wishes, we will communicate appropriately with you and work together to create the best experience for you.
  • We are unable to accept wish requests for ‘generic’ VISA/AMEX, Amazon gift cards, cash, or financial assistance (rent, mortgage, home repairs, car payments, student loan payments, medical expense reimbursement, fertility treatments, credit card payments, etc).