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.
- Applicants must demonstrate a clear financial hardship during and up to one year after 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 re-apply after 3 months and are required to complete the addendum (last page of this application) and provide updated/current bills.
- Applicants may apply for assistance a maximum of TWO times.
- The maximum combined total an applicant may receive is $3,000.
Apply ONLINE here:
Printed Application
For a downloadable, printable application:
New Applicant: Click Here
Returning Applicant: Click Here
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