Application for Financial Assistance

Unfortunately at this time SAS Cervical Cancer Foundation is not accepting applications for assistance. 
If you would like assistance planning an event for a loved one please contact us and we would be happy to share ideas with you.

SAS Cervical Cancer Foundation

Confidential Application for Financial Assistance

Click here to download application

 

The SAS Cervical Cancer Foundation is a non-profit organization who provides assistance only to individuals with cervical cancer. You will be notified by mail within 60 days as to whether or not your application has been approved. 

All applicants may re-apply after 1 year. 

Funds are limited and based upon availability and applicant’s need, and are in no way based upon race, creed, or ethnicity. 

"Assistance" may be in the form of a monetary payment to the applicant, a payment directly to a debtor, a gift certificate for staple items, or the like. Forms of assistance will be decided on a case by case basis by the Financial Aid Review Committee. 

Approval of this request grants a one-time assistance payment and does not necessarily promise future financial assistance. 

All information is held in the strictest confidence and is used only by the SAS Cervical Cancer Foundation for the purpose of reviewing financial assistance needs. 
 

 

 

 

 


Please return this application to:

SAS Cervical Cancer Foundation
Attn: Financial Aid Review Committee
2516 North Richmond St.
Appleton, WI 54911

 

 

PLEASE BE SURE TO

Answer each question or indicate if an item does not apply to your situation 
Sign and date the application
Have your doctor, nurse, or social worker complete the Medical Information section
Provide a phone number where you can be reached to answer any additional questions


Featured Photos