If you are human, leave this field blank. Show Form 2017 Help Now Fund Online Submission
The Help Now is a program for breast cancer patients, providing financial assistance for rent or mortgage, utility bills, cell phone bills, and car payments. All qualifying applications will be submitted to the committee and considered for aid.
Consideration and/or Submission DOES NOT GUARANTEE funding. Due to limited funds, eligible applicants are NOT guaranteed approval.
Before you begin please review all the FAQs, video, and required documentation. Applicants who do not submit all required documentation, in a clear, readable format, WILL NOT BE NOTIFIED that their application is incomplete.
To be considered the Applicant must:
1. Provide a copy of valid U.S. issued identification 2. Provide current (within 90 days) copies of bills and/or rental agreement, if the lease is out of date please provide us with a renewal letter. All documents must be clear where the committee can confirm the name, account number, and amount due on the bill. 3. Provide the first two pages of your most recent tax return document. This is required to expedite the grant process and comply with Federal tax auditing guidelines. 4. Provide a current (within 90 days) letter of treatment/diagnosis from a medical professional. This letter must be on professional letter head and include the patient's name, date, and medical professional signature. 5. Must be a U.S. Citizen or Legal U.S. Resident. All Legal Residents must attach a copy of their residence card as well as valid government issued ID. 6. The applicant may not have received $1000 from The Help Now Fund within the last calendar year 7. Applicants, please provide the Medical Release Agreement to YOUR medical professional listed on the application. Medical Release Agreements can be found here. 8. Applicants, please provide the Billing Release Agreement to YOUR utility company, mortgage company, and/or leasing agency. Billing Release Agreements can be found here. Disclaimer: DO NOT attach either the Medical or Billing Release to your application. These documents allow BCCA to retrieve basic information regarding treatment and billing. However, both are needed to complete the application selection process. Please provide these documents to the correct medical professional or company. If the applicant does not give the Medical or Billing Release documents to the appropriate party, the application may not be considered for funding.
Today's Date (Fecha) * Share your Story!
This is the portion of the application where the patient has the opportunity to greater explain to the committee how they feel the grant will help them in their breast cancer journey.
Tell us a little more about yourself. If funded how will the grant help you and your current situation? (Porfavor de darnos un poco de informacion sobre su condiccion y como te puede ayudar esta programa) *
I authorize The Breast Cancer Charities of America (BCCA) to use my words as well as
photograph me (or use provided photos of me & my family) and acknowledge that all
photographs become the property of BCCA and will be used exclusively for the
programs and advocacy efforts of BCCA.
I agree that The Breast Cancer Charities of America may also omit or selectively add
words for editorial purposes to my story as it will not change the intent of my testimonial.
I agree that The Breast Cancer Charities of America (BCCA) may use such
photographs of me with or without my name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content. Picture Upload (optional)
Before submitting your application make sure the application is completed in full. This includes:
Copy of Photo Identification A letter from a medical professional that was written within 90 days A recent copy (within 90 days) of bills which you are seeking assistance fornt or the first and last page of your lease ***Note if the lease is out of date we will need a renewal letter stating that*** The medical release form has been provided to your doctor's office The billing release form has been provided to the company for which you are asking assistance (utility/mortgage/leasing office/etc.)
All applicants will be notified no later than the 15th of the month. When you successfully submit your application you will receive a message and email stating it confirming a successful submission
By subscribing to the newsletters or forms as presented on our website, the individual acknowledges that they may be contacted by the organization with regards to educational news, events, requests for support or donations and that the individual affirmatively agrees to receiving any and all forms of the above listed communication.
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