Get Help – Angels' Place

If you or someone you know has a child diagnosed with a life-threatening disease, and live in the greater New Orleans area, your family may qualify to be Angels’ Place clients! We know your situation is tough, and we’d like to help.

Call Mary Kantlehner at (504) 455-2620 to find out if you qualify, or complete the application below. We also accept applications by mail, e-mail, or drop-off if you prefer to print and complete the form in writing.

See Contact Us for our location and all our contact information.

Please note, a social worker from Children’s Hospital or Ochsner Hospital may be able to help you apply. We also take home referrals from parents.

If accepted as a client family, you may have access to respite service and other types of support at no charge. Respite service volunteers generally visit children in the hospital to help make sure they get the attention they need. You may also benefit from our charity drives, and receive help from our staff in applying for other assistance programs. Not to mention the fun children’s events held just for Angels’ Place families!

View Application Form

Please note that "*" denotes a required field.

Applicant Information

For this section, enter information about the primary guardian/caregiver of the household

Applicant First Name *

Applicant Last Name *

Applicant Gender *

Applicant Date of Birth *

Number of children/dependants in your care *

Email *

Phone *

Street Address *

City *

Zipcode *

Child/dependent with life-threatening medical condition

If there is more than one, fill this out for the dependent with the most severe condition

Dependent First Name *

Dependent Last Name *

Dependent Gender *

Dependent Date of Birth *

Relationship to Applicant *

Legal Guardian (if not applicant) *

Diagnosis *

Date of Diagnosis *

Hospital *

Social Worker

Please provide a short description of dependent’s diagnosis and ongoing medical needs:

Certification By Applicant

I hereby authorize Angels' Place. (hereinafter “AP”) and its representatives, agents, employees or designees to contact me for the purpose of requesting any and all information concerning any pertinent information which they may have concerning my application. I also authorize AP and its employees, agents, representatives, and designees to investigate all statements contained in this application for decision.

I understand that the submission of this application for help to AP does not create a promise of help or the creation of a contract for help.

I certify that all information stated in this application is true and complete. I have read and understand the foregoing statement contained in this section entitled “Certification by Applicant.”

Certification by Applicant *

I certify that all information stated in this application is true and complete.