Financial Assistance Programs Pre-Qualification
(New Mexico Residents)
INSTRUCTIONS
To qualify for the PINK “ME” ® financial assistance programs please see the eligibility requirements below. This application, along with supporting documentation, must be submitted.
SUBMISSION DOES NOT GUARENTEE FUNDING
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We cannot guarantee that you will be selected for the program for financial assistance grant, even if you meet the qualifications and apply
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All information provided will be kept confidential
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Applications received are determined on a case by case basis- if not all required items are submitted, we will ask you to submit the documents before being considered
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Once all items are submitted, you will be notified via email within 30 days if you have received the financial assistance from financialassistance@pink-me.org
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If you need assistance completing this application, please contact us at financialassistance@pink-me.org, so we can provide you with assistance
QUALIFICATIONS
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Must be diagnosed with breast cancer and currently in active treatment for the Breast Cancer Treatment Assistance Program -OR-
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Must be a breast cancer survivor post one year treatment for the Survivor Health and Wellness Assistance Program
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Provide and submit all required documentation along with this application (please review Financial Assistance Documentation requirements on our website)
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Breast Cancer Treatment Assistance Program awards up to $1,500.00 financial assistance
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PINK "ME" provides up to $1,500 in financial assistance through direct bill payments over the course of 3 months (example $500/month x 3 months).
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Survivor Health & Wellness Assistance Program awards up to $600.00 financial assistance
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PINK "ME" provides up to $600 in financial assistance through direct bill payments over the course of 3 months (example $200/month x 3 months).
IMPORTANT INFORMATION
Our Financial Assistance Committee will review your online application and email you within 5 days, regarding your application status. If additional information is needed, we will contact you.
ALL APPROVED GRANTS ARE BASED ON FUNDING AND FINANCIAL RESOURCES AVAILABLE
Please direct all of your questions to:
financialassistance@pink-me.org
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PINK "ME" FINANCIAL ASSISTANCE
PROGRAM GRANTS ARE PROVIDED ON
A ONE-TIME BASIS ONLY
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