Get The Help You Need

Apply For Assistance

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 a maximum award of $500 per calendar year.
  • You must upload a certification from your oncology office to confirm your active treatment status. This form must be signed by your provider. Please download the form below.

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.
Step 1 of 4
Select all that apply. Maximum amount $500.