This form applies for a grant from Hand in Hand: The Suzanne R. Leider Memorial Assistance Fund. It is a program by the Sarcoma Alliance designed to reimburse out-of-pocket expenses related to a second opinion consultation with a sarcoma physician. Please note that we do not reimburse any out-of-pocket expenses related to the treatment of sarcoma.

You must submit the following information and receipts for consideration of grant funds. All receipts and supporting documentation MUST coincide with the specified date of the second opinion consultation. Please check all that apply and fill in the expenses on the corresponding lines.

In order to process this application, this section must be fully filled out and must be signed by the patient/guardian.

You can ask your physician to sign the form on your device during your consultation, or you can send the link to the form to their office for completion. Find the link on the Second Opinion Grants page.

This Assistance Fund strives to help sarcoma patients with support for non-reimbursed expenses directly associated with obtaining a second opinion from a sarcoma specialist. Grants are awarded for eligible expenses up to the maximum award limit per patient for a period of one year from the date of the first application. The AF will award eligible applications based on available funds. Receipt of an application with qualifying expenses does not ensure that funding will be at the maximum level requested. Applicants will receive a letter of acknowledgement confirming receipt of application. Grants are reviewed and approved on a quarterly basis, and notification of award will follow.