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The Provision Project knows that a breast cancer diagnosis can create tremendous financial pressure on a family.

To be considered, you must be in active treatment for breast cancer, with scheduled surgery, chemotherapy or radiation.

To apply for a grant from the Provision Project, please complete and submit the application below.  Applications will be reviewed weekly, and you will be advised of your application status as soon as possible.

Once your application is reviewed and accepted, funding will be provided that can be used to help with medical expenses, utilities, gas/travel, or general living expenses.  Funding amounts will vary and is based on availability.

Questions about funding should be sent to Michelle LaLonde.

 

Fields marked with an * are required

FUNDING APPLICATION

The mission of the Provision Project is to provide financial relief to women in active treatment for breast cancer.  Once your funding application is reviewed and accepted, funding will be provided that can be used to help with medical expenses, utilities, gas/travel or general living expenses.  Grant amounts will vary.

Your Information

 

Medical Information

Needs Information

Please attach supporting documentation (medical information, invoices, etc.) if necessary.  You may upload up to 6 files no more than 2MB in size.  The file formats allowed are .jpg, .gif, .png, .tiff, .pdf, .txt, .rtf, .doc, .docx, .xls, .xlsx.  Funding is based on availability.

Statement of Truth

I have examined this application and agree that the information is true and correct to the best of my knowledge.  I am aware that the information contained in this application is subject to verification.  I understand all statements in this application are made for the purpose of obtaining financial assistance from the Provision Project and that failure to provide requested documentation or any falsified information may result in denial of this request.  Funding is based on availability.  I agree that this application shall remain the property of the Provision Project. 

Provision Project, Inc. is a 501(c)(3) non-profit organization.