Application Packet

Send Me On Vacation Application

General Requirements For SMOV Application

  • Applicant must be diagnosed with breast cancer and have undergone treatment.
  • Applicant must demonstrate that she has endured economic disadvantage.
  • The Application must be made by the Applicant, not a friend or family member.
  • The Applicant must acknowledge that the Vacation will be safe and not be contraindicated by their medical providers.
  • Applicant must submit a personal story describing why they believe that their circumstances warrant the Survivors Committee for Send Me On Vacation, Inc. granting a Vacation to them.
  • Applicant must complete, sign and send the SMOV Application Form, Contact Information, SMOV Vacation Preferences, and SMOV Agreement to Send Me On Vacation, Inc.
  • Applicant must complete, sign and send the HIPPA (Health Insurance Portability and Accountability Act) form.
  • Applicant’s physician must fill out and return to Send Me On Vacation, Inc. the Medical Statement and Consent to Participate.
  • Please send three current original photographs of the Applicant via email in .jpeg or other high-resolution format. Please do not fax or mail photos. Send email to communications@sendmeonvacation.org.
Download the Application Packet

General Requirements for Returning Recipients (Angels)

    • Applicant must be diagnosed with breast cancer and have undergone treatment.
    • Applicant must be a SMOV Alumni from the Mermaid Empowerment program.
    • Applicant must raise $1,000 to cover the accommodations and food, but the cost of transportation to travel to and from the vacation destination is the responsibility of both applicants.
    • Applicant must like/follow Send Me On Vacation social media pages.
    • Applicant must complete, sign and send the SMOV Angel Application form to communications@sendmeonvacation.org.

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Download the Angel Application