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Assistance Request Form

The Stronger Together Foundation provides financial support to individuals and families facing cancer in Dickey and LaMoure Counties.

You may complete this form if:

  • You are a resident of Dickey or LaMoure County who has been diagnosed with cancer, or

  • You are nominating someone from Dickey or LaMoure County who is currently facing cancer.

To receive support, please submit proof of a cancer diagnosis — such as a doctor’s note or an appointment card — along with your application. Verification is required to ensure IRS compliance and preserve our tax-exempt status.

Please complete the form below to apply. Our team will review your request and follow up directly within 3 business days. If you do not receive a response, please check your junk or spam folder.

Please note: each individual may be nominated up to four times per calendar year.

Individual submitting application

Person in need of assistance (if different from the person submitting)

Your form has been successfully submitted and will be processed as soon as possible.

Upload File
Upload supported file (Max 15MB)

By submitting this form, you acknowledge that the individual listed has been diagnosed with cancer.

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