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How to become a Singleton MomMom with volunteers

In order to qualify for our services you must be…

  • At least 18 years of age
  • A single mother with at least one dependent living at home
  • Currently receiving Chemotherapy/Radiation and/or other cancer related treatments
  • In need of financial and/or household assistance

Steps to becoming a Singleton Mom

  1. Do you meet all the criteria above?
  2. Then complete the Service Request form below
  3. Your application will be reviewed and a Service Coordinator will contact you
  4.  If you qualify, the Service Coordinator will arrange a meeting and you will sign an agreement
  5. The agreed services will start for the duration of your treatment (up to a maximum of 9 months for financial assistance)

Do you meet the above criteria?  Then please complete this form. 

 

Personal Information:















 

Family Information:






 

Treatment Information:










This will not impact your qualification


Services Information:











      

 
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