The application can be downloaded from this site. You may print the blank application form and fill it out by hand and mail it. To maintain confidentiality, the application form cannot be transmitted electronically.

If you need help in translating or completing the application, please call the 800 number located at the bottom of each web page and CICRF staff will assist you.

To request that an application be mailed to you, please call or write:

Catastrophic Illness in Children Relief Fund
Massachusetts Department of Public Health
250 Washington St., 5th Floor
Boston, MA 02108-4619
phone: 1-800-882-1435 or 617-624-6060
TTY 617-624-5992

For assistance call 1-800-882-1435 (within Massachusetts), 617-624-6060, or TTY 617-624-5992.