(Use this form to refer a terminally ill adult for consideration for a charitable wish)
INSTRUCTIONS: The Zeuner Foundation grants requests for charitable wishes to adults age 18 and over who are either (1) diagnosed with terminal cancer or (2) caregivers of adults diagnosed with terminal cancer. In order to refer an individual for consideration, this form must be completed and submitted to the Zeuner Foundation.
This inquiry form is the first step in the Zeuner Foundation’s Charitable Wish Granting Process. It is not confirmation of eligibility for a wish (i.e., submitting a completed form is not confirmation that the referred individual is eligible to receive a wish). The information you provide will be shared with the Zeuner Foundation’s Wish Granting Team and you will be contacted by a member of the team about your referral. We will only contact you after a wish referral has been submitted by an approved referral source.
Eligible Referral Sources: Out of respect for the privacy of individuals and families we serve, we only accept referrals from the sources identified below:
If you are not eligible to refer an individual, please share the referral inquiry form with one of the eligible referral sources listed above or ask them to visit our website. **Please exercise compassion if you suggest to families that they contact us directly. A second-party introduction can be unsettling for a potential wish recipient or the family. The Zeuner Foundation strives to make its Wish Granting Process as comfortable and private as possible. Thank you for your consideration.**
