Request Assistance | The Gregg Pearson Foundation

GPF Assistance Requirements

Beneficiaries must live (or be receiving active treatments) within the immediate Dallas/Fort Worth Metroplex. We exist to help individuals that are battling cancer and other acute illnesses. We are not able to help individuals with injuries due to accidents, or chronic conditions and diseases.

After you submit this form, please check your email. You will be immediately emailed a link to fill out one more form.

We cannot review your request until you have completed and submitted the second form, which can be found here.

If you have any questions, please email: lucy@greggpearson.org

Contact Info for the Person/Patient in Need

Name of the Person/Patient in Need(Required)

First Last

Is Person/Patient in Need:(Required)

Male

Femaile

Age of Person/Patient in Need:(Required)

If Person/Patient is 17 or under, please list Parent Name(Required)

Email of the Person/Patient in Need:(Required)

Phone of the Person/Patient in Need:(Required)

Address of the Person/Patient in Need:(Required)

Street Address Apt # or Suite # if applic. City State ZIP Code

Hospital patient is being treated at?(Required)

Name of Social Worker (if applicable, if not applicable put NA)(Required)

Type of Cancer or Other Illness

YOUR INFORMATION (if not the patient)

Name(Required)

First Last

Email(Required)

Phone(Required)

Address(Required)

Street Address Apt # or Suite # if applic. City State ZIP Code

Relationship to Patient (if you are not the patient yourself)(Required)

(if you are the patient, type SELF)

How did you hear about us? (please give the person's name)

Please give a brief description of the person in need and how the GPF can help.(Required)

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