You can download and fill out the Application Form or apply online below.
By filling out the application form, you are acknowledging you have read and understand the Grant Restrictions and HIPAA guidelines. The completed Health Statement and the Income Documentation listed below are required in addition to the grant application.
With this application, you will need to email or mail the following before your application will be considered complete:
- Most recent Income Tax Return, or if a Tax Return has not been filed for either the current or last calendar year; then W-2s or
- Two recent pay stubs showing current income; or
- Social Security award confirmation letter; or
- Copy of Medicaid Card, or other Medicaid verification
If your Income Status changes, you must immediately notify the We Care Foundation to determine whether or not you continue to qualify for assistance.
Additionally, you will need to email or mail the Health Statement document. Download and print the Health Statement for your medical team member to complete and sign verifying your current treatment plan. Your submitted application will be processed once the completed Health Statement and require Income documentation has been received.