If you are an adult (18 or over) in the United States and have cancer treatment bills then please apply by using this form: Preliminary Donee Application (PDF)
- This form has been updated for Q2 2020 (April).
If you have submitted a form that doesn’t state “Revised March 2020” you will have to resubmit with the correct form.
- Please fill out the form in its entirety and submit it to one of the addresses on the top-right of the form.
- Currently our application windows are open in the months: January, April, July and October. If you apply in a month not on this list then we will carry over your application to the following application window.