Apply for Assistance




Below you will find instructions to apply for assistance with our organization. I understand that you are going through a lot and that paperwork may be the last thing you feel like dealing with. Please know that I would be happy to assist you in any way possible. If you have any questions about the paperwork or anything else please feel free to contact me (Dan)  any time at 518-956-2156. I will even come to you and help you with the paperwork. My top priority is doing everything I can to assist you during these tough times.


To apply for assistance from the Jill Paolucci Memorial Coalition Against Cancer, please click the image below. Then, print andcomplete the form. There are two ways to submit this application:


1. Scan the completed form and email it to dpaolucci226@yahoo.com     or

2. Mail the completed form to:

Jill Paolucci Memorial Coalition Against Cancer
​45 Snowberry Road Malta, NY 12020