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Who We Are
News
Assistance
Scholarship
Contact Us

Apply for Assistance

The Full of Hope Foundation is a group of volunteers who raise funds to assist cancer patients with their non-medical expenses.

Application Requirements:

You must be in active treatment (i.e. Chemotherapy, Radiation Therapy, Immunotherapy, or have had cancer-related surgery within the last 30 days) at an Arizona facility to be eligible for assistance.
Applicants can apply for maximum award of $500 per calendar year.
You must upload a signed copy of our oncology certification form. This form must be signed by your doctor and indicate that you are in active treatment at the time of your application. The form may be uploaded as a picture or a scanned document.

Important information:

Completing an application does not guarantee funds. Funds are dispersed based on need and funds available regardless of treating physician or where treatment is received.
The information provided on your application will be kept in the strictest confidence and used only for the purpose of determining eligibility.

Oncology Office Certification Form.docx Download

- Step 1 of 4

I have read and understand the eligibility requirements and important information, and I meet the requirements as listed. *

Yes

Are you a first-time applicant? *

Yes
No

How did you hear about the Full of Hope Foundation? *

Website
Hospital
Physician
Family
Friends
Other

Patient Name *

First

Last

Patient Date of Birth *

Phone Number *

Email *

Physical Address (Not a PO Box) *

Address Line 1

Address Line 2

City

State

Zip Code

Mailing Address (If different than physical address)

Address Line 1

Address Line 2

City

State

Zip Code

Purpose of Assistance Request *

Select all that apply. Maximum amount $500.

Name of person completing the form, if different from patient.

First

Last

Email address of person completing the form, if different from patient.

Physician Information

Facility Name *

Oncologist *

Oncology Office Certification *

Click or drag a file to this area to upload.

To be considered for assistance, you must upload a signed certification form. A blank form can be found on our website, linked just above the application. You must be under active treatment at the date of your application to be considered for financial assistance.

Oncology Social Worker name

First

Last

Oncology Social Worker email address.

Financial Information

Number of adults (18 and older) living in household *

Number of children (under age 18) living in household *

Patient Information: Employed and working *

Full Time
Part Time
Disabled
Unemployed
Employed but on FMLA/Disability/Leave
Student

Patient Employer *

Patient Monthly Income (including SSI, Disability, Alimony, etc.) *

Spouse Employer *

Spouse Monthly Income (including SSI, Disability, Alimony, etc.) *

Monthly income of other adults in the household (including SSI, Disability, Alimony, etc.) *

Monthly Expenses: Rent/Mortgage *

Monthly Expenses: Home Insurance

Monthly Expenses: Monthly Utilities *

Monthly Expenses: Car Payments *

Monthly Expenses: Car Insurance *

Monthly Expenses: Gasoline *

Monthly Expenses: Food/Groceries *

Monthly Expenses: Credit Cards *

Monthly Expenses: Child Care *

Monthly Expenses: Health Insurance *

Monthly Expenses: Medications *

Monthly Expenses: Other Medical Expenses *

Monthly Expenses: Other Non-Medical Expenses *

Please explain what your plan is to pay these accounts moving forward *

State Where Your Taxes are Filed *

Health Insurance Provider

Secondary Health Insurance (If Applicable)

Have you applied for assistance through Full of Hope within the last year? *

Yes
No

Please tell us your story *

I understand that checking this box constitutes a legal signature confirming that I acknowledge and warrant the truthfulness of all information provided in this application.

Signature Acknowledgement

Donate

Support Us and Change the Course of a Person’s Life Today!

When you make a contribution to the Full of Hope Foundation your money stays in Arizona. All of the donations received are used towards supporting patients and families with a cancer diagnosis.