Personal Background

OMF TAG travel grants are entirely need-based and disbursed at the sole discretion of OMF. Typically, individuals who earn, as a household, less than $100K annually will be considered though OMF prioritizes acute cases of financial need such as household income below $40,000 per year and/or instances where the patient has suffered financial hardship (for instance, lost their job) as a direct result of their eye cancer diagnosis). However, every case is different and we will do our best to assist you and reduce the financial burden of your treatment-related travel. 
1.Contact Information(Required.)
2.What is your gender?(Required.)
3.Birthdate (DD/MM/YYYY)(Required.)
4.Marital status:(Required.)
5.How many dependent children do you have? (must be shown on tax return)(Required.)
6.Have you applied to the OMF TAG Program before?(Required.)
7.If travel is being requested for a caregiver companion, please enter their
information here (name/address/relationship/etc.)