Please carefully review all qualifying information below, and instructions on the first page of the application. Application Guidelines:
- Applicants must reside in Delaware and be U. S. citizens, regardless of where they are receiving treatment.
- Applicant must currently be in active treatment, or within a year from completing active treatment. Active treatment includes surgery to remove tumors, chemotherapy, immunotherapy, and radiation. (Post treatment regimens such as endocrine therapy (tamoxifen, arimidex, anastrozole, etc) and plastic surgeries do not qualify as active treatment.)
- Applicants must demonstrate a clear financial hardship during treatment, and the inability to pay for current living expenses and/or medical bills.
- The application form must be filled out completely. (if questions do not apply, please write “N/A”)
- Confirmation of a cancer diagnosis and treatment must be provided by a physician, or other medical professional on the applicant’s medical team.
- Payments will be made directly to service providers – no funds will be given directly to patients or their families.
- Applicants may only apply for assistance one time. Once applicant is assisted, or applicant is denied due to not meeting criteria, they may not apply again.
Printed Application
For a downloadable, printable application:
Click Here to download Application
Completed forms, along with bills, can be scanned and emailed to [email protected] , faxed to (302)995-0807 or mailed to:
Cancer Support Community Delaware
4810 Lancaster Pike
Wilmington DE 19807