Please read the eligibility criteria and complete all fields in the application to be considered. The application process takes 4-6 weeks. We are not an emergency fund and cannot provide immediate financial assistance. Pink Warrior Angels of TX does not discriminate on the basis of race, religion, age, nationality, gender or ethnicity.


Allow 30 minutes to complete this process.


Pink Warrior Angels of Texas recognizes that a cancer diagnosis comes with unexpected costs and hardships. If you are experiencing financial hardship, we may be able to help alleviate some of the burden from monthly bills such as electricity, water, mortgage or rent, groceries, car payments, or transportation.

We do not provide any financial aid for business-related requests, credit card payments, repayment to friends or family, activities or vacations, or purchasing a vehicle.

Each month we evaluate applications received into our financial aid program from men or women who are currently receiving treatment for a cancer diagnosis. If you meet our criteria, we invite you to apply.


Eligibility:

*The applicant must be a legal U.S. resident.

*The applicant must be actively receiving treatment for a cancer diagnosis (i.e. chemotherapy, radiation, pending cancer surgery, etc.) or the applicant must be in remission or on long-term hormonal therapy or long-term targeted therapy.

*The applicant must have immediate financial needs that are not being covered by a spouse/domestic partner, parents, or other family members.

*The applicant is unable to receive financial support from other sources, entities, or organizations.

*The applicant cannot have received financial aid from Pink Warrior Angels of Texas in the previous 12 months.


What is Pink Warrior Angels of TX looking for in an applicant?

Our financial aid is for cancer warriors that can make a clear and direct connection between their current financial difficulties and their experience with cancer. Your personal story is an important part to the evaluation process. Please be sure to define how your financial struggle is a result of your diagnosis.


How much financial aid can I expect?

Financial aid amounts are dependent on many factors including, the donations, and fundraising success of the organization, the number of applicants that have applied, and the details provided in the application form.


When can I expect to see the funds?

Financial aid is paid directly to the creditor that is requesting the payment and not to the applicant. The status of your financial aid application will be determined 4-6 weeks after we receive all required documentation.


What information do I have to provide?

*Basic personal and contact information

*Information about your cancer diagnosis and treatment

*Your current financial picture including monthly income, monthly expenses, assets you may own, and liabilities/debts you owe

*A Medical History Verification letter signed by a licensed medical professional with whom you have a relationship (e.g., oncologist, primary care physician, nurse practitioner)

*2 months most recent pay stubs for the patient or spouse/caregiver

*Copies of bills listed on the application form

*Proof of US Residency/driver’s license


Email hello@pwatx.org with any questions.


Personal Information


Demographic Information

Providing demographic information helps PWATX receive specialized grants that can increase our financial aid funding. Thank you for helping us better help you!



Employment Information


Income and Expense Information

This information must be verified with supporting documents emailed to hello@pwatx.org. Instructions are provided at the end of this application.



Write a short paragraph

What’s Your Color? Tell Us Your Story

Your story is unique to you and helps us understand who you are and how your cancer diagnosis has affected your personal situation.



List your top 3 bills you need help with.

What are your top three financial needs? Please add company name, account number, amount due and mailing address of where payment should be sent (if approved) e.g. 1. ABC Light Company, Acct 123456, amt due $206.00, PO Box 8796, Leander, TX 765411



Would you like to create a fundraising campaign?

A fundraising campaign is created specifically for you which will allow you to share easily through social media, email and text to help raise money for your bills. If yes, you agree to the following: Provide your story, sharing the campaign, allow PWATX to use your story, provide a review after the completion of the campaign.


Funds will be mailed within 2 weeks of the campaign closing.



Care Kits

Chemo care kits are provided to those in active chemo treatments and require a start and end date. Mastectomy care kits should be requested 2 weeks before surgery and are only for breast cancer warriors.



Email Preferences

We like to keep warriors informed of important news, schedules, and volunteer opportunities by email. Use the checkboxes below to select the type of emails you would like to receive. (This can be changed later also)



Incomplete Applications Will Not Be Considered.

To complete this application you must send the following documents to hello@pwatx.org. If these documents are not received your application becomes invalid.


-Copies of the top 3 bills you requested help for. These must be for the most recent month and must include the amount due, name of biller, address to send payment, account number and account holders name.

-Medical History Verification Letter, SIGNED by a licensed medical professional with whom you have a relationship (e.g., oncologist, primary care physician, nurse practitioner)

-2 months of paystubs for applicant and/or spouse/caregiver

-Proof of US residency/Driver’s License



Verify

I certify that the information in this application is true and correct to the best of my knowledge. I understand that the information provided may be verified by Pink Warrior Angels of TX and I authorize them to contact third parties to verify the accuracy of the information provided in this application. I understand that if I Knowingly provide untrue information in this application, I will be ineligible for financial assistance. Any financial assistance granted to me may be reversed, and I will be responsible for payment of the bill(s). I also understand that it will take up to six week for notification for application decisions and will continue to pay my bills. I also understand that the information I send through email is not a secure messaging system, and the information is used for the application purpose. I authorize this form and its contents electronically.