Application to Apply for Help

How To Apply For Help

Our grants are up to $500, which are determinted based on need. To apply for Financial Assistance, click on the download link below.

To complete this application, you will need:
  • Patient Information (no SSN required
  • Medical Information of diagnosis - TO BE COMPLETED BY your oncology nurse, doctor, social worker or hospital
  • Signature of Medial Professional
  • Health Insurance Information (if applicable)
  • Brief description of circumstance and why you need the assistance
DOWNLOAD APPLICATION

Upon completion of the application, please email it to info@yeswecansir.org


Adobe Reader is Required to view or fill out the application.




If you have any questions, or need additional assistance with this application, please contact us