Examples of needs that can be funded include (but are not limited to) travel, rent, utilities and medication. If you or someone you know find(s) yourself/themselves with a diagnosis of cancer and are in financial need, the Festival of Hope may be able to help.
Please fill out the pre-application and mail it to: The Festival of Hope c/o Cancer Treatment Center 3911 Avenue B Scottsbluff, NE 69361, or call Carol Diffendaffer at 308-630-1348 or email her at cdiffen@festivalofhope.net . Further information will be requested to complete a formal application to ensure that the applicant has access to the maximum funding available.
Name of cancer patient: _______________________________________
Address: _
City: ______________________ State: ______ Zip Code: ____________
Phone: Day _____________ Evening _____________ Cell ____________
E-mail: ____________________________________________________
Cancer Type:________________________________________________
Date of cancer diagnosis: _____________________________
Name of facility where diagnosis was made: _________________________
Physician(s)
providing care for you: ______________________
Physician(s) phone numbers if not local: ____________________________
I authorize the Festival of Hope Board of Directors and its designee, The Regional West Foundation, to secure information regarding my diagnosis and treatment.
Signature of Applicant or Guardian:
_______________________________
Relationship to Cancer Survivor:
________________________________
Date: _____________
Click below to download a printable version of the application.
| Assistance App | |
| Assistance Preliminary Application.pdf | 486.4 KB |