Financial Support

Thrive to Survive is committed to helping survivors navigate financial challenges.  Our goal is to help you focus on what matters most, your health!

Through generous donations received from friends and families, local businesses, fundraising events, and grants, Thrive to Survive is offering emergency financial grants to adults currently in treatment for cancer.

Financial Assistance is available for all adults age 18 or older living in Ontario, Yates, Seneca, and Schuyler County, currently receiving treatments for any type of cancer.

Name *
Name
Address *
Address
Phone Number *
Phone Number
Alternate Phone Number
Alternate Phone Number
Date of Birth *
Date of Birth
Household Information
Marital Status *
Names and Ages
Employment
Current Employment *
Employer's Address
Employer's Address
Employer's Phone Number
Employer's Phone Number
Are you currently able to work? *
If not, when do you anticipate returning to work?
If not, when do you anticipate returning to work?
Are you receiving any of the following?
Insurance
Do you have health insurance? *
Diagnosis Verification Information
Date of Cancer Diagnosis *
Date of Cancer Diagnosis
Date and procedure
Treatment dates and names of therapies used
Treatment dates
Would you be interested in learning more about any of the following?
Agreement
Cancer Oncologist, Surgeon or Radiologist Written Verification *
Please request from your treating cancer doctor to provide you a letter verifying cancer diagnosis and treatment information. Specifically, we will need verification on type of cancer treatment you are receiving, treatment dates, as well as diagnosis. Letter needs to be provided on official letterhead and hand signed by doctor. You should email this letter to pam@thrivetosurvive.org.
Proof of Residence *
A copy of your New York State driver’s license, state ID or a copy of bill sent to your residence in your name must be emailed to pam@thrivetosurvive.org.
Authorization of Release of Information/Notice of Privacy *
By clicking submit you hereby authorize Thrive to Survive (TTS) to contact any party for information directly related to this grant application and making a decision to approve or deny the financial grant for assistance. TTS will demonstrate respect for your confidentiality, privacy, and security. Records and information are protected against loss, destruction, tampering and unauthorized access or use.

Instructions

Please review the Application Instructions document and complete this form. We are currently offering financial assistance up to $500.00 per 12 month cycle.

Apply By Mail

Please download the form below, answer all questions, and mail us your completed form, your proof of residency, and the written verification letter from your provider.

Financial Support Application

Mail To:
Thrive to Survive
466 Kilbourn Rd.
Rochester, NY 14618

Questions?

If you have any questions, please contact us at (315) 374-0626 or through our Contact Form.

 
 

Donate

Making a donation to Thrive to Survive will go directly towards funding our mission, programs and services.  We are passionate about providing support to cancer survivors. Help us continue our mission, take the next step: DONATE and encourage others to do the same.

 
 
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