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2023 sponsors/Donors

 
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A Non-Profit Breast Cancer Organization

Empowering Women in The Fight Against Breast Cancer

 

PINK "ME" provides information, networking opportunities, and knowledge to help women lead healthy, fulfilled lives within a supportive community. The organization empowers women to be their own advocates.

 
 
 

Helping one family at a time!

 
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PayPal Donation Option and 
Designate where you would like your donation to be allocated

 

Donations greater than $250 with your tribute message will be added on our Tribute Page.
Make a donation greater than $250 to honor a loved one's survivorship or recognize someone on their courageous fight against breast cancer, or a memorial tribute.

 
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A NON-PROFIT BREAST CANCER ORGANIZATION

Helping one family at a time!

connect with us:

  • Facebook
  • Instagram
  • TikTok
  • LinkedIn

View our Brochure

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JOIN OUR E-NEWSLETTER
Sign up today for PINK "ME" news, updates
and events!
 

Founder and President

Dr. Michelle Bean
 

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Treasuer/Director

Sherrie Webb

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Secretary/Director

Cynthia Smalls

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Financial Assistance Pre-Qualification Application 

Choose one grant quarter (select only one option- grants are paid over the course of 3 months): Required
Please indicate which program you are applying for: Required
Are you in active treatment? Required

Active treatment is defined as the period after a positive diagnosis of breast cancer has been made (with a diagnostic biopsy), and during which therapies are being administered, including surgical procedures to remove the cancer (e.g., single, or bi-lateral mastectomy, lumpectomy, axillary dissection, or sentinel node biopsy), chemotherapy or radiation. Active treatment does not include reconstruction surgeries or long-term hormonal therapies.

Select one
Proof of Income/ Employement Status of Applicant Required

All applicants must provide one (1) of the following proofs of income. If documentation cannot be provided, you may submit a written signed statement describing your income. Please circle what item of income you are including with this application.

 

  • W-2 statement

  • Three (3) most recent pay stubs

  • Last year’s income tax return

  • Written signed statement

YOUR STORY – Please share your breast cancer journey. This will not be shared unless approved in section E, but we will use your story to help make a decision of the financial assistance. Attach additional pages if needed.

AUTHORIZATION

 

If approved for the financial assistance, PINK “ME” asks for your permission to share your story with others to help raise public awareness of the organization, communicate to donors and community to support the cause, and inform breast cancer patients, healthcare providers, and others about the Organization’s services.

 

IMPORTANT: You do not have to authorize permissions, this will in no way affect your financial assistance status for the program.

 

I understand I have the right to revoke my authorization at any time by contacting PINK “ME” at info@pink-me.org or at the below address. Revocation will be effective upon receipt and affects disclosure moving forward and it is not retroactive. I understand that my approval or denial of permission will in no way affect the assistance provided to me by the Organization.

 

 

 

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Yes I allow PINK"ME" to use: Required

I understand that information disclosed may be subject to redisclosure and may no longer be protected by Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act.

I understand that PINK “ME” Organization owns all marketing and outreach materials as released by me, and I hereby release rights to these items. I understand I will not be compensated for the use of the released information. I have read and understand the terms of this release. I certify that I am of legal age, 18 years of age or older.

I understand that PINK “ME” ® may verify information by reviewing information and obtaining information from other sources to assist in determining eligibility for financial assistance or payment plans.

I affirm that the above information is true and correct to the best of my knowledge. I understand if the financial information I give is determined to be false, this may result in denial of financial assistance, and I may be responsible for and expected to pay for services provided.

 

IMPORTANT INFORMATION

Applicants selected in the financial assistance program(s) will be contacted via email from our financialassistance@pink-me.org email address. 

​

SUBMISSION DOES NOT GUARENTEE FUNDING

​

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Upload Treatment Verification Letter
Must be on facility letterhead only
Upload Bill Statement
Upload bill statement for review and approval
Upload Bill Statement
Upload Bill Statement for review and approval
Upload Bill Statement
Upload bill statement for review and approvall

To help us with your bill payments and submissions, please provide the billing address or the necessary information for making online payments.

​

All bills must be submitted at one time; partial submissions will not be accepted.

 

If you have any questions, feel free to reach out. We're here to support you.

Thank you for submitting your application for financial assistance. Our committee will review and get back to you within 5 days. Please note that all approved grants are subject to funding and financial resources available. If we need more information, we will contact you. For any questions, please email us at financialassistance@pink-me.org.

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Financial Assistance Pre-Qualification Application 

Choose one grant quarter (select only one option- grants are paid over the course of 3 months): Required
Please indicate which program you are applying for: Required
Are you in active treatment? Required

Active treatment is defined as the period after a positive diagnosis of breast cancer has been made (with a diagnostic biopsy), and during which therapies are being administered, including surgical procedures to remove the cancer (e.g., single, or bi-lateral mastectomy, lumpectomy, axillary dissection, or sentinel node biopsy), chemotherapy or radiation. Active treatment does not include reconstruction surgeries or long-term hormonal therapies.

Select one
Proof of Income/ Employement Status of Applicant Required

All applicants must provide one (1) of the following proofs of income. If documentation cannot be provided, you may submit a written signed statement describing your income. Please circle what item of income you are including with this application.

 

  • W-2 statement

  • Three (3) most recent pay stubs

  • Last year’s income tax return

  • Written signed statement

YOUR STORY – Please share your breast cancer journey. This will not be shared unless approved in section E, but we will use your story to help make a decision of the financial assistance. Attach additional pages if needed.

AUTHORIZATION

 

If approved for the financial assistance, PINK “ME” asks for your permission to share your story with others to help raise public awareness of the organization, communicate to donors and community to support the cause, and inform breast cancer patients, healthcare providers, and others about the Organization’s services.

 

IMPORTANT: You do not have to authorize permissions, this will in no way affect your financial assistance status for the program.

 

I understand I have the right to revoke my authorization at any time by contacting PINK “ME” at info@pink-me.org or at the below address. Revocation will be effective upon receipt and affects disclosure moving forward and it is not retroactive. I understand that my approval or denial of permission will in no way affect the assistance provided to me by the Organization.

 

 

 

​

Yes I allow PINK"ME" to use: Required

I understand that information disclosed may be subject to redisclosure and may no longer be protected by Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act.

I understand that PINK “ME” Organization owns all marketing and outreach materials as released by me, and I hereby release rights to these items. I understand I will not be compensated for the use of the released information. I have read and understand the terms of this release. I certify that I am of legal age, 18 years of age or older.

I understand that PINK “ME” ® may verify information by reviewing information and obtaining information from other sources to assist in determining eligibility for financial assistance or payment plans.

I affirm that the above information is true and correct to the best of my knowledge. I understand if the financial information I give is determined to be false, this may result in denial of financial assistance, and I may be responsible for and expected to pay for services provided.

 

IMPORTANT INFORMATION

Applicants selected in the financial assistance program(s) will be contacted via email from our financialassistance@pink-me.org email address. 

​

SUBMISSION DOES NOT GUARENTEE FUNDING

​

​

Upload Treatment Verification Letter
Must be on facility letterhead only
Upload Bill Statement
Upload bill statement for review and approval
Upload Bill Statement
Upload Bill Statement for review and approval
Upload Bill Statement
Upload bill statement for review and approvall

To help us with your bill payments and submissions, please provide the billing address or the necessary information for making online payments.

​

All bills must be submitted at one time; partial submissions will not be accepted.

 

If you have any questions, feel free to reach out. We're here to support you.

Thank you for submitting your application for financial assistance. Our committee will review and get back to you within 30 days. Please note that all approved grants are subject to funding and financial resources available. If we need more information, we will contact you. For any questions, please email us at financialassistance@pink-me.org

What to Know About Financial Assistance Support

Our financial assistance grants are provided on a one-time basis during each approved grant period. Once approved, all required bill submissions must be completed within the designated month to ensure timely and efficient processing.

To help set clear expectations, please note:

  • Approved funds are available only during the assigned grant period and do not roll over

  • Assistance is limited to eligible expenses within the approved program and does not cover past-due rent, mortgage, or car payments

  • All bills must be submitted together at one time; partial submissions cannot be accepted

  • Partial payments are not permitted

While these guidelines are necessary to ensure fairness and efficiency, our commitment remains rooted in compassion—working to ease financial stress wherever and whenever we can.

Financial Assistance Programs is now Closed!

 
 
 

Breast Cancer Treatment Financial Assistance Grant

Support for treatment-related needs
Grant amount: Up to $500

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Survivor Health & Wellness Grant

Support for healing, recovery, and overall well-being
Grant amount: Up to $250

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PINK “ME” Food — No Hunger Grocery Cards

Additional Support & Financial Assistance Guidelines

To further ease daily burdens, approved recipients of either program may also receive:

  • Up to $125 in grocery gift cards, accepted at approved grocery stores

To better meet urgent needs, grocery gift cards are provided in place of submitting a grocery list—allowing recipients the flexibility to purchase food when it is needed most.

 

Financial Assistance Guidelines

Our financial assistance programs provide support on a one-time basis. Once approved, all bill submissions must be completed within the designated grant month to ensure timely processing.

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Important Notes:

  • Approved funds are available only during the assigned grant period and will not roll over

  • Assistance does not cover past-due rent, mortgage, car payments, or expenses outside of the approved program

  • All bills must be submitted at one time—partial submissions cannot be accepted

These guidelines allow us to serve as many individuals and families as possible with the resources available.

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Application Timeline and Process​

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  • May - June (CLOSED)

​

Applications open during the month of May. Approved assistance is distributed, and bills are processed during the month of June.

All applications are reviewed with care and consideration, based on eligibility, available funding, and the timely submission of all required documentation.

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