Request Assistance
** You may submit your application with an understanding that it may be some time before SIS is able to help. At this time SIS has more requests for assistance than we are able to satisfy. SIS raises the majority of its funds throughout New York State, for this reason NYS applications will be considered before out of state applications
WHO WE CAN HELP:
Any person going through the battle of breast cancer treatment who needs financial assistance.
HOW WE CAN HELP:
We can provide grants for financial support of any of the following:
Rent/Mortgage
Utility Expenses
Vehicle Payments
Childcare
Groceries
Pharmacy Co-pays
Uncovered Prosthesis/Medical Clothing
Wigs
Transportation
WHAT IS REQUIRED:
A completed application, a completed Request for Physician Exam Report, and a completed Applicant Authorization for Release of Information form.
Grants will be awarded on an individual financial need basis. Funds will be granted as they are raised and provided on a first come, first served basis. Sensational In SurvivalSM will not base awards on race, color, creed or any other criteria aside from financial need during breast cancer treatment.
Download Word version of form
(includes Request for Physician Exam Report and Applicant Authorization for Release of Information)
Download PDF version of form
(includes Request for Physician Exam Report and Applicant Authorization for Release of Information)
