Financial Assistance Program Application

Applications are reviewed by Have FAITH Foundation, Inc staff for completeness and whether the patient meets eligibility criteria. If the patient is approved for assistance, the referring professional is notified by phone or email regarding the amount of assistance. Financial Assistance checks are made directly to the creditor owed. Therefore, applicants must supply copies of the bill.

Eligibility Criteria

Applicants must meet the following qualifications to be considered for aid:

  • Reside in United State
  • Must be at least 18 years old.
  • Must have a cancer diagnosis as certified by healthcare provider.
  • Must be in active treatment or within a six-month period of cancer treatment.
  • Patient declines active treatment and is admitted to hospice services.

Applicants can be referred by a physician, physician assistant, nurse, social worker, or account representative.

Have FAITH Foundation, Inc

Financial Assistance Program Application. All requests for funding must be presented in writing using this form. Please include any other supporting documents.  By submitting this form you agree to our privacy policy and terms and conditions.