Apply for Assistance

Use the current application below to request support from the JMCF Patient Assistance Program.

Download the 2026 Financial Assistance Application (PDF)

Before submitting

• Complete every applicable section.
• Sign the patient or guardian consent.
• Obtain the required signature from the treating oncologist, radiologist, or qualified oncology social worker.
• Include the requested vendor or billing information so approved assistance can be paid directly.

For questions, call (315) 339-5993 or email contact@thejmcf.org.

Organizational grant requests

Hospitals, treatment facilities, hospices, foundations, and other qualifying organizations may use the Grant Proposal Form (PDF).