The Anthony Poselovich Foundation is in honor of, Anthony Poselovich, who passed away November 8, 2010 as a result of complications from hepatoblastoma. Hepatoblastoma is an extremely rare childhood liver cancer that affects roughly 1 out of every 1,000,000 children born in North America every year.

Anthony was born on March 15, 2006 and was diagnosed at 11 months old on February 20, 2007. He fought bravely for almost four years, enduring countless rounds of chemotherapy, a liver transplant, and numerous surgeries to remove metastatic tumors from his lungs and lymph nodes. He also survived two life threatening infections during his long, tough battle.

Throughout the course of his illness, Anthony remained a constant source of inspiration and strength. He was always laughing, smiling, joking, and having fun no matter the circumstances. Most importantly, Anthony was a loving and caring little boy who, even at the tender age of four, always put the feelings and the welfare of others before his own. He hated to see people upset or suffering, and he would do whatever it took to ease their trouble and put a smile on their face. He always succeeded. We’re quite sure had he lived, he would have dedicated his life to helping others in some fashion.
The mission of the Anthony Poselovich Foundation is to assist families with children up to age 5 who have been diagnosed with cancer and are in financial need. Our goals are to supplement unpaid medical expenses, funeral and obituary costs, as well as to fund activities to be done with siblings.

Application For Assistance

Child's Information

Full Name (required)

Gender (required)

DOB (required)

Address (required)

Primary Phone Number (required)

Alternative Phone Number

Diagnosis (required)

Date of Diagnosis (required)



Name of Physician(s) (required)

Primary Hospital (required)

Primary Social Worker

Primary Social Worker Telephone

Medial Insurer (if any)

Does the child reside with both parents?

If not, with whom does the child primarily reside?
Name



Relationship

Relationship

Address (if differnt from child's)

Phone (if differnt from child's)

Email

Parent/Guardian2

Relationship

Address (if differnt from child's)

Phone (if differnt from child's)

Please list any other members of the household, their names, ages and relationship and any siblings whether residing with child or not:

Member 1

Age

Relationship

Residing in home?

Member 2

Age

Relationship

Residing in home?

Member 3

Age

Relationship

Residing in home?

Member 4

Age

Relationship

Residing in home?

Member 5

Age

Relationship

Residing in home?

Member 6

Age

Relationship

Residing in home?

Employment Information for Parents/Guardians

Parent/Guardian 1 Are you employed?

Name of Employer

Employer Phone

Occupation

Monthly Income

Parent/Guardian 2 Are you employed?

Name of Employer

Employer Phone

Occupation

Monthly Income

Please list any other sources of household income and the amount of income from each source ( please include child support, alimony, SSI, other persons working in household):

Please briefly explain any other factors contributing to your economic hardship or reason for requesting assistance:

Assistance Requested

Financial Assistance for Medical ExpensesFinancial Assistance for Funeral Expenses*Financial Assistance for Obituary Expenses*Sibling Activity, please specify**Other( travel, food, lodging, etc...)***

*If applying for funeral/obituary expenses, is there a life insurance policy, or any
type of insurance that will cover any cost?

If yes, please explain.

**If applying for sibling activity, please specify.

***If applying for other, please specify.

Have any financial gifts from any other organizations or businesses been applied for/granted?

If so, please provide details.

How did you learn about The Anthony Poselovich Memorial Foundation?