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  • Ray of Hope Cancer Foundation

  • Once you have filled out your portion of the application click the "Save" button and you will be given the option to "Get Draft Link". Click this button and send a copy of the link to your Social Worker to fill out the required medical verification portion of the application. The Social Worker will submit the application once this section is completed.

  • Applying to Ray of Hope for a grant

    Ray of Hope provides a financial grant known as the Cancer-Related Financial Toxicity (CRFT) Grant. Based on the information you provide your eligibility will be determined for our grant.

    CRFT Grant

    The CRFT Grant provides $500 ($1,000 for pediatric patients) to Colorado cancer patients in active treatment and dire financial circumstances. If you receive this award, the check will be made out in your name.

    Do you meet the eligibility for the CRFT grant?

    1. I am 18 years or older or am the parent/guardian of a patient under 18.
    2. I am a Colorado resident.
    3. I have a cancer diagnosis.
    4. I am currently receiving cancer treatment that includes chemotherapy, targeted therapy, immunotherapy, radiation, or surgery, or I have completed one of these treatments within the past month.
    5. I have a dire financial circumstance (expenses must be greater than income to meet this eligibility requirement)

    If you have answered YES to every question, you are eligible to apply for assistance from the unrestricted fund.

     

  • FIRST STEP | TELL US WHO YOU ARE

    The application can be started by the patient or their assigned social worker

  • IF YOU ARE A SOCIAL WORKER FILLING OUT THE APPLICATION WITH A PATIENT, START BY CHOOSING "PATIENT". THE MEDICAL VERIFICATION PORTION IS THE LAST SECTION WITH THE SUBMISSION BUTTON. 

  • Once you have filled out your portion of the application click the "Save" button and you will be given the option to "Get Draft Link". Click this button and send a copy of the link to the patient and/or yourself.

    The link will open the application up to the portion you have already filled out. You or the patient will click the "Back" button at the bottom of the page and it will take them/you to the start of the application, with the option to choose "Patient".

    This will open up the patient portion of the application to be completed and submitted. 

  • Patient Application Form

    To be completed by patient/grant applicant or parent/guardian if patient in under 18
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  • Three Optional Questions

    The questions marked with an * are optional, and your answers are confidential. This information is reported generally and anonymously to help policymakers and advocates better understand and address health disparities in underserved groups. Occasionally, additional funds may be available for some under-served groups.


  • Household Information

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  • Income & Assets

    Tell us about your total household income THIS MONTH. Please report gross earnings (before taxes or other deductions). You'll be able to report the amount you pay in taxes and deductions and attach copies of income from entire household (paystubs, social security letters pension statements, etc. before submitting) later in the application.
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  • Expenses

    Please list ALL your household expenses for every single member of your household THIS MONTH so that we have an accurate picture of you financial situation. IMPORTANT - Prioritize your expenses in the "Priority Need" column with #1 being the most important expense. You will need to attach copies of you first and second marked top priority bills.
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  • Top 3 Needs

    Check the box based on the order they rank in need (Example: #1 need is support for housing, #2 need is food, # 3 need is transportation.) *If you have one or two needs please choose "Other" for the second and/or third need.
  • Ray of Hope Cancer Foundation

  • Signature Required

    I certify that the information provided on this application is true and accurate to the best of my knowledge. I authorize Ray of Hope Cancer Foundation to obtain from the individuals, businesses, organizations, agencies or entities listed in this application whatever information necessary about my case that might be helpful for assessing my application. I release Ray of Hope Cancer Foundation of all liabilities or claims arising out of the donation of money or services provided to me or my family.
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  • Ray of Hope Cancer Foundation

  • Ray of Hope Medical Verification Form & Grant Application

    HIPAA Compliant

  • THIS PAGE MUST BE COMPLETED BY A REFERRING PROFESSIONAL

    Do not use abbreviations or codes for diagnosis and treatment. Do not send medical records.

  • Describe current treatment (begin & end dates are required)

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  • This page must be signed by referring professional (caseworker, patient navigator, social worker, nurse, or physician)

    My signature below affirms the diagnosis and treatment information as described on this page.

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