Get Stephen A. Comunale, Jr. Family Cancer Foundation

This guide provides comprehensive and supportive instructions on completing the Stephen A. Comunale, Jr. Family Cancer Foundation application online. Follow these steps to ensure your submission is thorough and accurate.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to access the application form and open it in your preferred editor.
2. Begin filling out the patient information section. Clearly print the last name, first name, and date of birth. Provide the complete address, phone number, and indicate the patient's gender and employment status.
3. Continue with the total monthly household income, including any contributions from family members. Indicate if assistance has been previously received from the Foundation or other organizations and provide details as needed.
4. In the physician and treatment information section, fill out the patient's last appointment date and next appointment date. Include the oncologist's name and the medical facility details.
5. Provide health insurance information, including the insurance company name and details on prescription drug coverage.
6. Elaborate on the cancer diagnosis and treatment history in the designated area, ensuring to capture any details relevant to the application.
7. Document the request for financial assistance by specifying the type of assistance sought (e.g., utility bills, rent, child care). Attach copies of all relevant bills to substantiate your request.
8. Review the application privacy statement and sign it, indicating your agreement. Ensure that the patient or legally authorized representative's signature and date are included.
9. Grant verification permission by signing the appropriate section, allowing the Foundation to verify all provided information.
10. Share your story in the provided section, detailing the personal challenges faced during the cancer journey. This narrative will help communicate your situation to the committee.
11. Once the application is fully completed, save any changes made, and prepare to send it to the Distribution Committee of the Foundation, ensuring all required documents are attached.

Complete your application online today to receive the support you need from the Stephen A. Comunale, Jr. Family Cancer Foundation.