Eligibility & Commitment

We are dedicated to providing support to those facing serious illness. Our commitment is to ensure that no individual or family is left behind in their health journey. If you, or someone you know, is in need of assistance, please reference the eligibility criteria below and complete the application.

Have a confirmed diagnosis, or relative with a confirmed diagnosis, of cancer or other serious illness.
Demonstrate financial need related to costs as a result of diagnosis.
Provide documentation as requested (medical verification, bills, lease, etc.).

Assistance Application

Assistance Approval Process

1. Application submitted by patient or advocate

2. Review by Assistance Committee or designated Board members

3. Conflict check performed

4. Approval by majority vote

5. Funds disbursed directly to vendors when feasible

This application is used to request financial assistance from Shepherds of Care. Submission does not guarantee funding. Applications are reviewed by the Assistance Committee and/or Board based on eligibility, available funds, and organizational policies. Someone from our team will respond as soon as possible regarding your application status.

Section 1 - Applicant Information

First name

Last name

Email address

Phone number

Date of Birth (of individual with primary diagnosis)

Section 2 - Medical Information

Please provide the recipient's primary diagnosis and their treatment facility (if applicable).

Section 3 - Requested Assistance

Tell us a little more about yourself and/or the recipient if you are applying on their behalf. We love to get to know who you are, what you enjoy doing, and all your favorite passions in life! Please provide a brief description of how funds may be used.

Section 4 - Supporting Documentation

The Shepherds of Care team will email you regarding supporting documentation once your application has been reviewed. Documentation may include, but is not limited to, medical verification, relevant bills/invoices, lease/lodging documentation, etc.

Section 5 - Applicant Certification

By typing my name below, I certify that the information provided is true and complete. I authorize Shepherds of Care to verify information as necessary. I understand assistance is subject to review and available funding.

Date of your signature and submission of application:

Month

Day

Year