the process of applying for financial help:
To Receive Financial Help from Support Healing:
- Patients must have received a breast cancer diagnosis;
- Patients must reside in the Southern California area;
- Patients must be in active treatment for breast cancer;
- Patients must have a child or children under the age of 16;
- Applicants must have a household income of less than 5 times of the Federal poverty level based on last year's federal tax return.
APPLICANTS MUST CONSIDER THE FOLLOWING ITEMS BEFORE APPLYING:
- Support Healing cannot provide emergency funding nor disburse immediate financial assistance;
- Every applicant must follow the steps of the application process before receiving financial aid;
- Valid proof of a current diagnosis must be provided on official letterhead - signed and dated by an Oncologist, Licensed Social Worker, Nurse Navigator, or Patient Advocate;
- Support Healing may provide up to $3,000 in direct bill assistance towards the payment of mortgage or rent, insurance/medical bills, utility bills, car payment, and groceries;
- Bills must be able to be paid in full to be considered, no partial payments will be made;
- Please provide current contact information, including an email address, as our communications will be electronic;
- Support Healing does not discriminate on the basis of race, religion, age, nationality, gender or ethnicity.
the application process:
The following forms must be completed in their entirety and submitted electronically (via email) to:
- Application for Financial Assistance;
- HIPAA Privacy Authorization Form;
- Medical Information Form (cannot be self-completed);
- Medical Team Contact Information and Initialed Consent Form;
- Financial Disclosure Form;
- Employer Letter;
- Physician Letter; and
- Tax Returns (copies of your IRS Form 1040)
Please follow the Application Checklist (found below) and submit all of the forms together. Make sure to provide your email address and contact information.
For questions regarding the application process, please call (818) 523-6524.
Individuals who falsify any information on their application for funding or withhold information regarding Support Healing’s definition of active treatment or employment status, will be required to immediately reimburse Support Healing for any payments administered on their behalf. Support Healing reserves the right, in its sole discretion, to approve applicants and to suspend any further payments that have been awarded to said individual.