Application for Assistance

Who is Eligible?
Income Guideline (cannot exceed):

Household Number Income Yearly* Income Monthly
1 $21,000 $1,750
2 $28,200 $2,350
3 $35,400 $2,950
4 $42,600 $3,550

* Income before taxes. All Applications are evaluated on a case by case basis.  Please return completed application to Kim Monson, Program Coord.

Housing Assistance

To qualify for Housing Assistance, a patient must have at least 2 consecutive days of treatment.  If they meet the financial and treatment guidelines, a free night of housing may be issued for every two days of consecutive treatment.  Emergent cases will be determined by Case Management.

Travel Assistance

Travel Assistance is intended to defray the financial burden of traveling for cancer treatment.  The income guidelines apply.  Patients will receive pre-paid gas cards once a month, based on receiving active treatment and distance from the treatment center.