Apply for Support

Jack’s Assistance Program is the heart and soul of our organization, providing everything from high-tech wheelchairs to prosthetic limbs, from appointments with specialists to custom-designed eyeglasses or hearing devices for local children up to the age of 21. This program also offers financial assistance to families of children with cancer or special needs to help with transportation, food and housing costs associated with out-of-area treatments.

An application is required to qualify for Jack’s Assistance Program. Our goal is to help your family, so all applications are reviewed with the goal of providing some sort of assistance.

If you have an emergency, please call us at (805) 547-1914 so that we can attempt to assist you urgently.

Otherwise, the initial application process is as follows:

Please download and fill out the following application and then upload to the form below.


Otherwise, for returning families, the paperwork is simplified as follows:

Select the buttons below for your type of requests. We have a Request Form for "TRAVEL" to a Medical Appointment, or "OTHER" for our therapy programs, medical equipment, etc.

Appointment Travel AssistanceSolicitud De Viaje

Request for Other AssistanceOtra solicitud de asistencia

To apply for assistance, please fill out the appropriate paperwork as noted above. You can now complete the forms online in both English and Spanish. Send the completed application to, fax it to (805) 592-2018 or mail it to:

Jack’s Helping Hand
P.O. Box 14718
San Luis Obispo, CA 93406

Initial Applications and Assistance Requests are kept for 2 years. After 2 years, a family must complete a new full Application.

For more information regarding Jack’s Assistance Program, email