Minton Lodge Request Form

This application is a formal request to use the Minton Lodge in Aberdeen, Ohio, at no-cost, for the purpose of a therapeutic, respite stay. The process is as follows:

1. Complete the online application
2. Participate in a Zoom meeting with a Stay Coordinator
3. Obtain formal approval for an upcoming stay
4. Schedule your visit at a time convenient for you

A Stay Coordinator will be in contact with you throughout this process.

The applicant is a person who has been:

• Diagnosed with any form of cancer regardless of current remission status

OR

• A caregiver of an individual who is or has been diagnosed with any form of cancer, regardless of current outcome

OR

• Active duty, Reservist, or honorably discharged Veteran of the US Military

The applicant or another person on behalf of the applicant may submit this application

The requirements for the applicant are:

1. Is a US Citizen
2. Provide valid, legal identification
3. Regularly communicates using email
4. Has a mobile phone
5. Is comfortable driving on dirt, back roads, or will be traveling with someone that meets this same requirement.
6. If in active cancer treatment, have the primary medical provider who is most knowledgeable of their cancer history and current medical status complete an online release form, which includes the primary physician, oncologist, or oncology nurse. The form link will be provided in the initial email correspondence

Due to the Minton Lodge being remote, is of sufficient health as to not likely require critical health services during your stay.