Financial Grant Request Application

What is the Family Cancer Network Financial Grant Program?

The Financial Grant Program is available for qualified, blood cancer patients, with significant financial need, to help with ancillary expenses such as transportation/travel, prescriptions, or expenses due to lost wages and all other non-reimbursed medical expenses incurred while in treatment. A grant is available for qualified patients.

Program Criteria

  1. Applicant (patient) must be a US citizen and permanent resident of Iowa, which is verified by applicant’s physical address.
  2. Applicant must have a confirmed diagnosis of blood cancer.
  3. Applicant may be insured or uninsured.

How to Apply

If you fit the Program Criteria, please fill out the following form. After you submit, you will receive an email with a link to download the Application.

If you don’t have an email address, leave that field blank and we will mail you an application.