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APPLICATION FOR A WISH

When time matters most.

Apply for a Bucket List Experience

Apply for a bucket list experience through Buckit! Just Live Courageously. We help adults age 18 and older living with non-curable cancer step away from being a patient, spend meaningful time with loved ones, and create memories when time matters most.

You may apply for yourself or complete this application on someone else’s behalf. When applying for another person, enter that person’s information in the applicant fields.

A few things to have ready

Please have the applicant’s contact information, emergency contact information, physician’s name and contact details, and a description of the experience ready. Physician information is needed to verify eligibility.

Applying is free. Submitting an application does not guarantee approval or funding. Each request is reviewed individually, and timing depends on eligibility verification, available funding, and the coordination required.

What happens next

Our volunteer team will review your application and contact you about additional information or next steps.

Need help completing the application? Contact info@buckitjlc.com.

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APPLICANT INFORMATION

Applicant Name
Address
Emergency Contact Name

MEDICAL INFORMATION

Your physician's information is required to verify eligibility.

ELIGIBILITY QUESTIONS

YOUR WISH

Tell us about the experience that would mean the most.
Agreement
Clear Signature

Application questions

Who can apply for a bucket list experience?

Adults age 18 and older living with non-curable cancer may apply. Your physician’s information is required so our team can verify eligibility. Describe the bucket list experience that would mean the most to you and the people you hope to share it with.

Can I apply on someone else’s behalf?

Yes. You may complete the application for another person. Enter that person’s name, contact details, medical information, and experience request in the applicant fields. Have their emergency contact and physician’s contact information ready before you begin.

What happens after I submit my application?

Our volunteer team will review your application and contact you about additional information or next steps. Submitting an application does not guarantee approval or funding. Timing depends on eligibility verification, available funding, and the coordination needed for the requested experience. If you need help, contact info@buckitjlc.com.

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Looking for additional support?

Buckit’s Cancer Resources Directory connects patients, caregivers, and families with trusted organizations offering financial assistance, transportation, lodging, support groups, grief resources, daily living help, and more.

View Cancer Resources