Lungs Matter Grant Application Form

Welcome to the Lungs Matter APPLICATION for the home radon mitigation support.

Name*

First NameLast Name

E-mail*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

This grant is for individuals who have either been diagnosed with lung cancer or meet moderate to low-income eligibility.

All applicants will be required to upload the following documents:

C-NRPP Certified radon test results (this is a long-term 3 month test kit)
mitigation quote

Applicants who are applying based on the income criteria need to upload the following document:

notice of income assessment
previous tax year return

Applicants who are applying based on the diagnosis of lung cancer need to upload the following document:

Proof of diagnosis (ex. letter from doctor)
Or a referral a provincial cancer managment organization. (Ex. CancerCares MB or provincial equiveliant)

Applications will be reviewed monthly by a review committee. Selected applicants will be notified of their grant applications' success when funds become available. Applicants who are not selected need not apply again as their application will remain in the selection pool and be re-assessed the following month.

Grant applications will not be considered for radon mitigation work already completed. However, once the grant is applied for, please feel free to have the work completed while you wait for notification on your application status.

Have you or anyone in your home been diagnosed with lung cancer?*

yesno

Eligibility for this grant is aligned with the Community Volunteer Income Tax Program (CVITP), using the following income thresholds. Which category do you fall under?*

1 income household with annual income under resident Provincial Median Income2 income household with annual income under resident Provincial Median Income3 or more persons with household incomes under resident Provincial Median Incomeother

Please enter your radon level on your long-term radon test report before mitigation, showing your radon level is above 200 Bq/m3

Number of occupants in the home requiring mitigation.*

Please state the cost before sales taxes based on a quote from a radon mitigation professional.

UPLOAD THE FOLLOWING DOCUMENTS:

1) Notice of Assessment OR Proof of diagnosis

3) Long-term C-NRPP certified radon test report

4) Mitigation quote (from a C-NRPP professional)

UPLOAD - notice of assessment OR proof of diagnosis*

UPLOAD - Long-term radon test report*

UPLOAD - Radon mitigation quote (from a C-NRPP professional)*

The following questions are optional, they will provide some statistical information for The Lung Association, Manitoba Inc.

Have you delayed mitigating your home due to the costs associated with mitigation?

yesno

Does this grant increase your ability to implement mitigation in your home?

yesno

Are you a permanent resident or Canadian citizen?

yesno

Do you or anyone in your house smoke?

yespreviouslyno

Has Covid-19 increased your interest in testing for radon in your household?

yesno

How did you hear about this grant?

Please verify that you are human*

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