How Do I Get Help?

You may apply for funds to help with added expenses while going through the cancer fight. Before sending the application, please read the directions for completing the packet.
The Application Packet (with directions) is available to download in pdf format.

All three forms included in the packet must be returned to the GCCC board to have your request acted upon.

Submit completed packet (includes 3 forms) to:

ATTN: Application Committee
Grant County Cancer Coalition
PO Box 105
Lancaster WI 53813

1)	Application Form
All areas must be completed (except those marked GCCC office use) Please give as much information as possible. Please sign and date form.
2)	Authorization for Disclosure of Health Information
This form must be filled out by the applicant before seeing your doctor. Leave a completed copy at the doctor's office to have placed in your medical record and keep a copy with you to mail to GCCC with your completed application. Please let your doctor / nurse know a member from GCCC board will be calling to verify the cancer diagnosis. Make sure the form is signed at the bottom.
3)	Diagnosis Verification Form
This form must be completed by your doctor.

Our mission is to assist cancer patients living in Grant County Wisconsin. As applications are submitted, each will be given a case number, allowing as much confidentiality as possible, with only one board member knowing the applicant's name. We are dedicated to being fair to everyone and it is our hope to be able to meet the needs of everyone who applies.

Assistance is available up to 3 times with a maximum funding amount of $1,500.00 each time.

Applications are verified and final approval is authorized at the earliest board meeting. The volunteer board meets the first Wednesday of each month. If your application arrives after the first Wednesday of the month, your application will not be looked at until the following month.

Application Forms and Directions for Completing the Packet

Complete Application Packet and Directions