Event Date

Saturday
June 16, 2018

Our Mission

The Festival of Hope is a grass roots fundraising event organized by volunteers committed to assist area cancer patients during the treatment.  

Donate Here

 

 

 

Assistance Application 

The Festival of Hope is a non-profit organization whose mission is to help cancer patients and their families in the service area of Regional West Medical Center.  Assistance can help with non-medical expenses as related to their cancer care and treatment.   There is a sincere interest by the Festival of Hope and our regional community to lend a hand to as many persons as possible who qualify for assistance.


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  jennifer.hiltgen@rwhs.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.


IMPORTANT:

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: ______________________________________________________________

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: _______________________________________________________________

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:  ____________________________________________________________________ 

 

 Date: ____________________________

 

Click below to download a printable version of the application.

Click Here for Forms

 

 

 

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