Financial Assistance Application

Applicants must:

*Have had a diagnosis of breast cancer.

*Be (or become) a member of BCAK to be eligible to apply. The membership fee is $35/year, and a receipt may be issued.

Breast Cancer Action Kingston offers financial support to those individuals residing in and receiving their treatment within the South East Cancer Region.

Are you a member of BCAK?
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If paying $35 at time of submitting application, please click Membership Form below

Verified diagnosis of Breast Cancer:
Do you and/or your spouse/partner have a benefit plan to assist with costs?
Have you applied to other agencies to assist with costs?
What is your current employment status?

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.

Applicant's requirement for funds:

As of May 1, 2022    Financial Cap: Up to $1,500 per year including any items below.  Total maximum allowance per person of $3,000.

  • Prosthesis - $250 every 2 years

  • Partial Prosthesis - $80 every 2 years

  • Wigs - $350  - 1 per hair loss due to treatment

  • Bras (maximum 2) - 60% every 2 years

  • Lymphedema - $1500 with max $3000

Note: If you have already applied prior to May 1 and received the maximum amount at that time, you are eligible to apply again in Jan 2023.

Upload Supporting Documentation

Thank you for your submission.

AMOUNT APPROVED: __________________                       DATE: ___________________________

 

SIGNATURE: __________________________________________                         PAYABLE TO: _____________________