Turning Pain into Power for Teens fighting Cancer

A MIP Room Makeover is to transform a boring hospital room into a cozier, more personalized space that is filled with things that will offer comfort, and inspire healing during a teens extended hospital stay. Please allow 48 hours for us to get back to you regarding this submission. Once a teen is approved, and their unique interests are identified, we will need some time to get the personalized items for the makeover. We will then coordinate with the nominator/hospital to coordinate the makeover.

Teen Name

First Name

Last Name

Anticipated start of Inpatient Stay / Estimated length of Stay?

Any Special Needs / Restrictions?

Example - BMT patient can not have items that can not be washed (decorative pillows, etc)

Favorite Colors:

Favorite Music

Favorite Sports

Favorite Sport Teams

Favorite Celebrities/Sports figures

Favorite Activities

Favorite Books

Favorite Movies/TV Shows

Hobbies/Things the teen likes to do:

Any Additional information that will help us get to know the teen?

Nominator statement:

Why is this teen in need of support from the MIP Foundation? How can we tailor our service to this teen to best help them cope with their cancer treatments?