Quincy University Women’s Basketball Hawks Fund In cooperation with the Blessing Foundation and Blessing Cancer Center Nominate a Blessing Cancer Center patient to receive a special gift or event as a memory to share with their loved ones and friends. Applicants will be chosen quarterly (Sept, Nov, Jan, Mar) by the QU Women Hawks Basketball Team. Any patient of the Blessing Cancer Center is eligible. The Blessing Foundation will arrange the memory with the patient/family. If you have questions, please contact the Blessing Foundation staff at 217-223-8400, ext. 4800; or email blessingfoundation@blessinghealth.org Name of Recipient First Name of Recipient Last Name of Recipient Name of Nominator (If different than above) First Name of Nominator (If different than above) Last Name of Nominator (If different than above) Contact Phone Number Contact Email Guesstimate Amount of Money Family Member Who Can Also Provide Input First Name Of Family Member Who Can Also Provide Input Last Name Of Family Member Who Can Also Provide Input Family Member Phone Number Why would patient like to be chosen; share their courageous battle; strength to endure; hope for the future; dreams to fulfill and memories to be made. Explain what gift or memorable experience patient would like to receive: Desired Date of Event/Memory Examples of past memories cancer patients have chosen: weekend away and shopping in Ozarks; dinner and a movie; a laptop; bouquet of roses and heart shaped box of chocolates; weekend with friends at a sportsman challenge; concert tickets in St. Louis with an overnight hotel stay; money to drive to family members home out of town; plane ticket to Vegas; go to the State Fair, while also camping, and visit the Springfield museum with family; Fun City weekend in Iowa with family; weekend fishing trip to Mark Twain Lake, sleeping in a cabin, and having a fishing guide show top fishing spots; family trip to Florida and staying with family; catered barbecue dinner with family; plane ticket to visit grandchildren and daughter in Seattle; family dinner catered at home and a bouncy house for the children; a professional family photograph taken and a day at a spa. (Wishes vary. Costs vary. There is a dollar limit.) * If chosen consent forms will be signed by the patient before the Creating Memory story is shared with persons outside of the Cancer Center and Foundation staff. Submit Leave this field blank
