Financial Assistance Application
*Have had a diagnosis of breast cancer.
*Be (or become) a member of BCAK to be eligible to apply. The membership fee is $30/year, and a receipt will be issued.
Breast Cancer Action Kingston offers financial support to those individuals residing in or receiving their treatment within the South East LHIN.
If paying $30 at time of submitting application, please click Membership Form below
Financial Cap: Up to $1,000 per year including any items below. Total maximum allowance per person of $2,000.
Prosthesis - $150 every 2 years
Partial Prosthesis - $50 every 2 years
Wigs - $250 every 2 years
Bras (maximum 2) - 50% every 2 years
Please check the reason(s) for financial assistance and attach any relevant documentation and/or proof of purchase receipts. Missing information may cause a delay in processing the application.
Thank you for your submission.
AMOUNT APPROVED: __________________ DATE: ___________________________
SIGNATURE: __________________________________________ PAYABLE TO: _____________________