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Connecting Children Impacted by Cancer Intake Form

Livestrong, Hopecam, and Monkey in My Chair are partnering to serve and support school-aged children affected by cancer. Requests for support will be facilitated by all three non-profits, and will include the following:

Livestrong at School- Provides age-appropriate resources for school professionals, parents and families including classroom lesson plans for grades K-12, engaging videos and printable worksheets to educate students about the impact of cancer and empower them to take action in the fight against cancer.

Hopecam- Assists children impacted by cancer with connecting to school and classmates. Provides the technology needed to connect with the child's school and support system, i.e. Tablet or Chromebook and a hotspot for internet are provided, if needed. Schools are provided with loaner laptops and Logitech Conference cam Connect Tower.

Monkey in My Chair- Provides Monkey In My Chair kits to children to help them stay connected to their peers. The Monkey Kits include a large stuffed monkey, backpack, journal, photo album, children's book and a teacher companion book.

Please complete the form below to request items for a school-aged child in need
The CCIC is intended to be a 3 way partnership between Livestrong, Hopecam, and Monkey in My Chair, serving children ages 5-15, Grades K-9. If you are interested in one specific program, but not all three please complete a request form at the appropriate organization's website:

Livestrong at School: https://www.livestrong.org/school

Hopecam: https://www.hopecam.org/apply

Monkey in My Chair: http://www.monkeyinmychair.org/get
1. Requestor Information (Adult):
This question requires a valid email address.
3. Recipient Information (Child):