There are 2 Parts in the Application Process:

You must be the patient to complete these steps.

Part 1: Online Application Form

Complete your online application form (part 1) by clicking on the state in which you live in below.
You will receive an email after completing part 1 online with a link to complete part 2. * CHECK your spam folders if it does not show up in your inbox.
Email address must be applicants not a nurses email. We communicate thru email, if we can not communicate to you and you do not respond you will be denied.
It is only fair that we are able to communicate with you if we are trying to give you a gift of financial assistance and not waste your time or ours.

Part 2: Downloadable Form and Attachments

Once you have completed the Part 1 online form you will be provided with a downloadable form in your email instantaneously. Don't forget to check your inbox and even your spam folder.
You must complete, sign, and provide required documents and returned to PRR via email.
Part 2 must be received all at one time in one email. DO NOT SEND MULTIPLE EMAILS.
Applications will be considered incomplete if Part 2 is not received all at one time.
PUT YOUR NAME IN YOUR EMAIL SUBJECT LINE.
DO NOT over send us paperwork. Keep it simple with just the few things we are looking for.

Click onto the state in which you live in, this will take you to the Application Form - Which is Part 1:

MINNESOTA

WISCONSIN

WYOMING

Please review if your state has an area we are not accepting before applying for the states listed below:

*MICHIGAN - Limited

*Not accepting patients from the Detroit area

*NEW YORK - Limited

* Not accepting patients from the NYC, Staten Island or Long Island area

Check Counties Here

Definitions of "Open" and "Closed" periods and the Financial Assistance Distribution

*Open Period- The open date is the date that we begin accepting applications. The length of time that applications are accepted will vary based on the amount of people applying.

*Closed Period- The closed date is the date when we stop accepting applications. The time frame between the closed date and the Financial Assistance Distribution date is the date on which the approved applicants are awarded.

*Financial Assistance Distribution Date- The Financial Assistance Distribution date is the date on which the approved applicants are awarded.

*Other times of the year we are fundraising to make the giving possible.

If you are a new referrer to our program as a nurse/ social worker or cancer center. Please click on: "ADD ME" to be added to our referrer list. This will add you to our system so you can refer patients to us and be updated on the opening and closing/ changes to our program. Please do not email us to ask when the program will open. We will notify all by email once you have asked to be on our referral list.

ADD ME