Apply For Assistance With The Cost of Your Cancer Treatment
***CCNF cannot currently guarantee review of patient applications. You may apply and we will keep your information on file until such time that review is open once again..***
The Cancer Care Network Foundation raises funds to provide financial assistance to patients with an active cancer diagnosis. Our financial assistance grants help patients with co-pays and deductibles required for commencement or completion of cancer therapy.
**At this time, we do not provide cash assistance for non-treatment related needs. We are also unable to provide aid to patients outside of California.**
If you or someone you know is in need of financial assistance for cancer therapy, please complete and submit the forms below (both patient and healthcare provider), or you may print and mail in a hard copy application* (you do not need to do both). Scan and email, or mail in your remaining documentation as outlined in the application.
*Click here to access the Patient Financial Aid Application PDF
Cancer Care Network Foundation
Attn: Financial Aid
541 W. Colorado St., Ste. 105
Glendale, CA 91204
And/or Email to:
Fulfillment time of grant requests vary and can take anywhere from 30-90 days from the time of submission. No requests can be granted without a completed application and all required documentation from your provider and insurance company.
Required Documentation: Please submit the following information with your application via mail or email.
Diagnosis (MD Summary Note) and MD Signature.
Valid California ID (i.e. driver’s license, etc.).
Explanation of Benefits (EOB) Form from your Insurance Company
Bill/Invoice for co-pay or deductible due to your provider.
Income verification for all sources of household income. This may include:
Two most recent payroll stubs and/or social security and pension statements.
Copy of your most recent 2 years federal tax returns. If you are required to file, or if you are claimed as a dependent, a copy must be included with your application.
Bank statements (2 months).
Copies of both the front and back of your medical and prescription drug insurance card(s).
Current credit report (free credit reports are available online).
***If you are not: required to file a federal tax return, or if your household income has changed significantly since you last filed a federal tax return, please call the Cancer Care Network Foundation (818-800-5806) to determine what information you should submit to verify household income.***