Pink Fund Financial Assistance Pre-Qualification

What was the date of your diagnosis?

What date did you or your spouse/partner stop working or start working reduced hours due to the breast cancer diagnosis?

Are you in active treatment?

Active treatment is defined as the period after a positive diagnosis of breast cancer has been made (with a diagnostic biopsy), and during which therapies are being administered, including surgical procedures to remove the cancer (e.g. single or bi-lateral mastectomy, lumpectomy, axillary dissection, or sentinel node biopsy), chemotherapy or radiation. Active treatment does not include reconstruction surgeries or long-term hormonal therapies.

Yes

No

Are you in active treatment?

Is long term hormonal therapy such as Tamoxifen or Arimidex your only treatment?

Yes

No

Is Tamoxifen or Arimidex your only treatment?

Has your household working income decreased?

Yes

No

Has your household working income decreased?

Did your spouse/partner experience a loss of income due to your breast cancer diagnosis?

Yes

No

Did your spouse/partner experience a loss of income due to your breast cancer diagnosis?

Do you meet the household income of 500% or less of the federal poverty level* based on last year’s federal tax return?

* Click here for the 2024 poverty guidelines.

Yes

No

Do you meet the household income of 500% or less of the federal poverty level* based on last year’s federal tax return?

Pink Fund Financial Assistance Pre-Qualification

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