Step 1:

Confirm Eligibility

✔ Cancer patient in active treatment in Nebraska or Council Bluffs, IA
✔ Meet household income guidelines
✔ Read and accept our Grant Restrictions

Please refer to our Eligibility and Restrictions document for more information

Step 2:

Gather information needed for the application

1. Patient Information: First and Last Name
, Address
, Date of Birth
, Gender, 
Marital Status, 
Phone, 
Email address, 
Alternative contact
, Phone number
 and Language Preference
2. Provider Information: The application must be completed by a member of the patient’s medical care team to confirm treatment status
3. Provide Proof of Income: Recent Tax Return, w-2′s, Most recent pay stubs, and/or Benefit award letter(s)
(total household gross monthly amounts from all sources); Bank Statements not currently an accepted form of POI
4. Expense documentation: Include the the application current eligible bills and/or mileage travelled roundtrip for medical appointments. We are not able to assist with credit card debt, personal loans, student loans, or medical bills and this time.
5. Incomplete applications: Applications will not be reviewed until all required documentation is received

Step 3:

Apply for Assistance / Solicitar asistencia

English Application

Aplicación en español

Step 4:

What Happens After You Apply?

• Rolling Review—Applications are reviewed on a first-come, first-served basis
• Notification by Mail when a decision is made
• Payments Sent Directly to Vendors in most cases, unless requesting gift cards
• Annual Renewals if still in treatment and meeting income eligibility (renewals bases on month of first application)
• End of Assistance up to 3 years or after lifetime maximum is reached