Tina’s Place Applications for 2017 Season are Now Closed. We are excited to meet all of our 2017 families that meant all the requirements and have been selected by our committee.




PLEASE DO NOT APPLY UNTIL YOU COMPLETE THE FOLLOWING STEPS:
 
  • Read the Tina’s Place FAQ page on our website to understand all the requirements prior to filling out an application. "DO NOT APPLY UNTIL FAQ HAVE BEEN READ"
     
  • ALL applicants must "like" our Facebook page or follow us on Twitter.

    Facebook: LIKED us here; YES or NO
    https://www.facebook.com/tinasplacemi

    Twitter: LIKED us here; YES or NO
    https://twitter.com/tinasplacemi

    If you fail to do so, your application will not be processed.
     
  • Fill out the application on our website in its entirety.
     
Requirements for Tina's Place attendance:
Patient (adult or child) must have a current diagnosis and be under treatment for Stage III or Stage IV melanoma. If application is approved, patient will be required to supply medical verification and clearance from their oncology healthcare team. Previous guests may not apply.

*NO PETS ALLOWED

Applications are NOT first come, first served. Once your application is received, the board will review it closely and inform you only if your family is selected to attend. Due to the large volume of applications, we cannot respond to every application.

Note: The application which follows asks if this would be your family's only getaway for the year. Please apply, whether your answer is yes or no. While we do not restrict our guests to only those who have no other vacation options we're especially eager to assist those families who have no other opportunity to escape the daily grind of melanoma treatment.

To apply, fill out the following form. Please don't forget to Like/Follow Tina's Place on Facebook and/or Twitter before submitting your application.

*Tina's Place reserves the right to fill dates and offer/rescind an invitation with or without explanation, cause, or reason.

* Indicates a Required Field

Guest Information
* Required Questions:
  I have read the FAQ page
  I have liked/followed Tina's Pace on Facebook or Twitter

Would this be your family’s only chance of a getaway/vacation?
   Yes    No
* First Name:
* Middle Name:
* Last Name:
* Email:
* Home Phone:
(Numbers only please, no spaces or special characters)
* Cell Phone:
(Numbers only please, no spaces or special characters)
* Address:
Address 2:
* City:
* State/Province:
* Postal Code/Zip Code:
Birthday:
Age:
Sex:
Your Facebook Personal Profile URL:
(ex: https://www.facebook.com/tinasplacemi)
Dates and Guest Information
Please check 3 dates that work for you:
June 05 - June 11
June 12 - June 18
June 19 - June 25
July 10 - July 16
July 17 - July 23
July 24 - July30
July 31 - August 06
August 07 - August 13
August 14 - August 20
August 21 - August 27
September 11 - September 17
September 18 - Setptember 24
September 25 - October 01
October 02 - October 08
October 09 - October 15
All of these dates work for me!
Number of family you'd like to be considered to join you at Tina’s Place (not more than four) Only immediate family, kids 18 and under:
Names, Ages and Relationship of those attending:
Cancer Diagnosis Information
Initial Diagnosis:
Stage:
Oncologist Name:
Oncologist Phone:
Medical Treatment and Limitations
Explain what treatment you are currently on:
Can you climb stairs to get down to the cabin:
Do you have any physical limitation:
Please explain why you should be selected to be our guest. Include any information you deem appropriate, such as financial hardship (including need for gas money), and whether this would be your family's only chance for a getaway. Provide any other information that may help with our Application Committee review process:
How did you hear about Tina's Place?
Form Validation

Please enter text in image:

Once we receive your application, we will review it closely. Due to the large number of applications we receive, you will only be contacted if you are selected.

If you have any questions, please contact us at tinasplacemi@yahoo.com. We look forward to reviewing your application!


"Take care of your body. It's the only place you have to live."
- Jim Rohn