2016 Enrollment is: OPEN
We are currently accepting applications.
Applications are processed one time per year in the spring, beginning April 1. The application may be available to patients during the months prior to that date — please continue to check our site to determine whether it can be accessed (if it can be accessed, you will see the link). If the application is unavailable, it is because the funds for the year have been dispersed and the program is closed — or, if you are checking early in the year (January or Februrary) it may be that we have not yet posted the application for the year. Prior to filling out an application, see Who Is Eligible? for current participation criteria.
The application is a time consuming process — please do not fill out the form if you do not meet the requirements. Keep in mind that you must meet the requirements at the time the applications are reviewed (example: if, in March, you have finished treatment more than two months ago, you are no longer eligible). Patients should be referred by a hospital social worker (or, submit in advance a note regarding why the L.C.S.W. is not involved in the case) and must meet with the Director, Jackie Whittier Kubicka. All participants are asked to provide proof of citizenship and a photograph (for administrative purposes) before receiving funds.
1. Please make sure you have Acrobat Reader by going to:
Start > Programs > Acrobat Reader.
If the program is installed, you will see it. If you do not see it or are not sure you have it, download a free copy here (link to Acrobat reader: http://get.adobe.com/reader/)
2. Please click on the following link, Application Form, to begin application. If application is not available, it is because funding period is closed. The link to the application is:
3. At the end of your completed application, you will see instructions on how to save and send your application. You may want to print the completed application for your records.
4. We will review your application and if selected we will contact you for further information.
If you are eligible, please click: Application Form