Financial Assistance for Patients

• Qualifications
• Referral
• Cover Letter and Application
• Grant Application and Grant Request Verification Forms

Qualifications (effective October 1, 2009, through September 30, 2010)

• Grant applicants must have a cancer diagnosis and be currently receiving medical treatment for cancer.
• Grant applicants must be a Colorado resident or receiving treatment in Colorado.
• Grant applicants must be 18 or older.
• Annual household income cannot exceed 60 percent of the Colorado median income level. See chart for income levels for 2009/2010

Household Size	60% of Colorado Median Income
1 2 3 4 5 6	$23,774 $31,090 $38,405 $45,720 $53,035 $60,350

Referrals

• All applications must be accompanied by a completed Grant Request Verification Form.
• Applications will not be considered complete without a verification of a cancer diagnosis and current treatment from a healthcare professional (physician, nurse, social worker, or patient navigator).

Grant Application and Grant Request Verification Forms

• You may call or write to request a Financial Assistance Application.
• Only completed applications will be accepted.
• Applications that are incomplete will be returned to patient and must be completed before resubmission.
• Applications may be completed by patient with help from any healthcare representative.

Cover Letter and Application

• Applications must be received no later than 5:00 p.m. on the 1st and 15th of each month.
• Applications received after the deadline will be reviewed the following month.

Mail completed applications and supporting documents to:
Rocky Mountain Cancer Centers Foundation
1161 S. Vivian Street
Lakewood, CO 80228

Applications may also be faxed to us at: 303-984-4344

Application Download (PDF 63k)

Click the above link to open it or right click to download the file. The application is a PDF. If you do not have Adobe Acrobat Reader, please click on the icon below to download the free software.
Adobe Acrobat Reader download icon: http://www.adobe.com/products/acrobat/readstep2.html

How we process your application

• Applications are reviewed by the RMCC Foundation staff. Incomplete applications will not be considered and will be returned to the referring health care professional to be completed.
• If an applicant is approved for assistance, the referring professional will be notified by phone or e-mail regarding the amount of the assistance.
• Financial assistance checks are made payable to the vendor and sent to the applicant for mailing to the vendor.
• If applicable, a voucher or coupons for food will be sent directly to the patient.

What we fund

The RMCC Foundation's financial assistance typically pays for the most basic of needs: food, housing, utilities, transportation, and medicines. This support helps reduce the stress of maintaining daily routines during treatment and contributes to retaining dignity and quality of life.