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 form (see link below or "Forms" page) and mail it to: The Festival of Hope c/o Cancer Treatment Center 3911 Avenue B Scottsbluff, NE 69361, or contact Jennifer Hiltgen at 308-630-1348 or firstname.lastname@example.org or submit an Online Assistance Application, (see "Online Assistance Application" page).
Further information will be requested to complete a formal application to ensure that the applicant has access to the maximum funding available.
If you do not receive a reply within two business days, please contact Jennifer Hiltgen at 308-630-1348, Thank you.
Name of cancer patient: ____________________________________________________________________________
Name of parent or guardian if applicable: ______________________________________________________________
City: _______________________________ State: _____________________ Zip Code: _______________________
Phone: Day ________________________ Evening __________________________ Cell _________________________
Date of cancer diagnosis: ___________________________________________________________________________
Name of facility where diagnosis was made: ____________________________________________________________
Physician(s) providing care for you: _________________________________________________________________
Physician(s) phone numbers if not local: _______________________________________________________________
Please know every effort will be taken to maintain strictest confidentiality!
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: ____________________________________________________________________
Click below to download a printable version of the application.