The Cancer Care Centers of Brevard Foundation (CCCF) provides financial assistance to under insured cancer patients living in Brevard and Indian River County undergoing active cancer treatment. As a nonprofit organization, funding is limited and all applicants are encouraged to create a plan for long-term support as well as applying to CCCF.
Funding is currently available for:
Utilities (water, sewer, electric, phone, etc.)
Transportation (to and from treatment)
Bills are paid directly to the provider (landlord, utility, etc) once approved.Eligibility
In order to be eligible for financial assistance you must:
Have a diagnosis of cancer confirmed by an oncology health care provider
Be in active treatment for your cancer
Live in Brevard or Indian River County
Meet our eligibility guidelines of 250% of Federal Poverty Guidelines
|Household Size||Gross Family Income|
Complete the application form in its entirety.
Fax (321-952-8830) or scan and email to firstname.lastname@example.org
A copy of your most recent pay stub, unemployment check, or SSI, SSD, public assisstance benefit nofication or bank statement
If you do not have income, provide a letter of support from friend or family member
You will be contacted within 7-10 days. Note: Submission of an application does not guarantee approval.
If you have questions about this form or need assistance in completing, please call 321-952-8837.
All information is strictly confidental and for CCCF use only