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.
If paying $35 at time of submitting application, please click Membership Form below
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.
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
Upload supported file (Max 15MB)
Thank you for your submission.
AMOUNT APPROVED: __________________ DATE: ___________________________
SIGNATURE: __________________________________________ PAYABLE TO: _____________________