PLEASE READ PRIOR TO COMPLETING THE FORM BELOW TO APPLY

Welcome to Pink Practicalities! This program is designed for people who are experiencing financial hardship while in active treatment, recovery for breast cancer, and live in the Vancouver-Portland metropolitan area. This form must be completed by a care provider and is protected by a HIPAA-compliant forms processor so the patient information is protected. Distribution Per Fiscal Year (1/1/22-11/30/22): approximate $800 limit per application, yearly limits apply and are subject to fund availability. Reapplication is allowed, during active treatment as funding allows. Funds are limited.  Priority must be given to patients experiencing extreme financial hardship. Applications will be reviewed and responded to within 30 days. Completion of the form does not guarantee approval for funding. Asterisk denotes a required field.

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