Alexis' Angels Application






Alexis' Angels is a holiday gift-giving program named in honor of Alexis White, who was diagnosed with leukemia at the age of 15. Inspired by the loving memory of their daughter, Jim and Patty White deliver holiday gifts to the children of families touched by blood cancer with the help of their Alexis' Angels volunteers. Our Angels deliver more than just gifts -- they deliver support and cheer during the holiday season. 

Program Guidelines
1. Program serves families touched by a blood cancer diagnosis, where the patient has received active treatment within the calendar year (any time in 2014).
2. All children (through age 17) whose primary residence is that of the selected household are eligible to be gifted through the program.
3. Families must be matched with an Angel in order to participate in the program -- we will do our best to find Angels for every family.
4. Financial hardship assessments are based on applicants' written summaries.  No finanical documentation is required.
5. Families must be residents of Illinois or Northwest Indiana. 
6. All information must be submitted to apply.
 
Registration Requirements
1. Complete this application form
2. Complete a Needs & Wishes list for each child residing in your household (through age 17)

If your family meets the Program Guidelines, please complete this Survivor Profile and Hardship Statement application.  If approved, you will also need to complete a Needs & Wishes List for each child.

 
*Completion of this application does not guarantee that you will be selected as an Alexis' Angels Gift Recipient Family.
Survivor Profile
* This family is:
* Phone number is for:
Phone number is for:

* Current Treatment Status:
Name(s) and age(s) of child(ren) through age 17 residing in household

Hardship Statement

Please indicate how your family has been affected financially by blood cancer and how you would benefit from being approved for this program.
0/300 words
The Alexis' Angels selection process is based on diagnosis and need as described by the applicant.  Therefore, no reporting of financial income or financial documentaion is required from families.  Alexis' Angels is a first come, first served program based on the date your application is received in the LLS office.  However, we reserve the right to reject applications that do not meet the program requirements.

Completion of this application does not guarantee that you will be selected as an Alexis' Angels Gift Recipient Family.  You will be contacted regarding the status of your application within five (5) business days.

If you have specific questions, feel free to contact Nida Rashid at nida.rashid@lls.org or 312-568-7732.

* Indicates Response Required