HOUSTON- AREA BREAST CANCER ASSISTANCE PROGRAM (BCAP)

HOUSTON-AREA SURVIVORS BREAST CANCER ASSISTANCE PROGRAM (BCAP) APPLICATION

BCAP is supported by The University of Texas MD Anderson Cancer Center
(Spring/Summer 2026)
BCAP HISTORY & IMPACT

Sisters Network® Inc. Karen E. Jackson Breast Cancer Assistance Program is one of leading breast cancer survivor financial assistance and early detection mammogram programs in the United States. Founded in 2006, the BCAP has provided over 1.6 million dollars in financial assistance and free mammogram screenings.

BCAP is designed to assist breast cancer survivors in active treatment facing financial challenges while undergoing surgery, radiation or chemotherapy treatment. BCAP is open two times per year for the Spring/Summer and Fall/Winter cycles.
OPEN FEBRUARY 3, 2026 - SEPTEMBER 30, 2026
(To be considered for Financial Assistance, please provide the following)

1. Completed BCAP Application

2. Required Email Address: Must be provided to receive progress updates

3. *UPLOAD ONLY ONE: Utility bill (Gas, Electric or Water), Lease Agreement or Mortgage Statement (must show mailing address and applicant name)

4. Signed Terms and Conditions

5. You must be currently IN ACTIVE TREATMENT and provide proof of receiving one of the following treatments or treatment plan (IV/Port Chemotherapy or Radiation)
ALL INFORMATION MUST BE COMPLETED.
- Only complete applications will be processed. *Incomplete applications will not be reviewed and/or processed*
- Please allow 30-45 days for review and processing.
- If approved, payments are made directly to the Third-Party Provider.
- Submission of this application does not imply or guarantee approval of financial assistance.
Note: BCAP program may close early due to funding being depleted or extended if additional funds additional funds are received.
APPLICATION CLOSES SEPTEMBER 30, 2026 - 6PM (CST)
How did you hear about the Breast Cancer Assistance Program (BCAP)?*

Sisters Network websiteBreast Cancer SurvivorEmailCancer Organization please listFacebook/Instagram/TwitterOther
Cancer Organization please list
How have you been impacted?*

Lost health insuranceHad a treatment plan changeLost jobOther
PICK ONE ITEM- Assistance will be awarded up to $350*

Utility Bill (Gas, Water, Electric)RentMortgage
$150 Grocery gift card

HEB
Utility Bill, Lease Agreement, or Mortgage Statement. (Applicant name must be on bill/statement)*

Cancelof
PERSONAL INFORMATION
Today’s Date*

MonthDayYear
Date
First and Last Name*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Age*

20-3031-4041-5051-6061-7071+
RACE/ETHNICITY (check one)*

Black or African AmericanAsianHispanic or LatinoAmerican Indian or Alaska NativeWhiteNative Hawaiian or other Pacific Islander
Are you a member of a Sisters Network Affiliate Chapter?*

YesNo
If YES, what chapter?
Have you received BCAP assistance in the last 12 months? (Eligible once per year)*

YesNo
FINANCIAL STATUS
Are you currently employed?*

YesNo
Please name occupation*
If No, state reason*
Annual Household Income*

under $25K$25K-$49K$50K-$69K$70k+
Head of Household?*

YesNo
Number in Household*
List Sources of Income*

EmploymentChild SupportPublic AssistanceFamily/friends provide supportSocial Security (Retirement)PensionDisabilityUnemployment
EDUCATION LEVEL*

Some SchoolGEDHighSchool GraduateSome CollegeCollege GraduatePost Graduate
BREAST CANCER STATUS
Year diagnosed*
Have you had multiple diagnoses?*

NoYes
If yes, how many?*
Type of Breast Cancer*

DCISTNBCIDCHER2+HR-InflammatoryMBCOther
Current Stage of Breast Cancer*

Stage 0Stage 1Stage 2Stage 3Stage 4
TREATMENT

(Applicants must be in ACTIVE treatment during application period)

*Hormonal pills are not eligible*
Currently in Treatment?*

YesNo
Type of treatment*

IV ChemotherapyRadiation Therapy
Treatment Dates*
(Attach letter from physician for verification)*

Cancelof
Treatment/Medication*
PHYSICIAN CONTACT
TERMS AND CONDITIONS
- ALLOCATION OF FUNDS: Sisters Network® Inc. (SNI) Board of Directors allocates certain monies and other resources to the Breast Cancer Assistance Program (BCAP) through the annual budget. The number and size granted by the Breast Cancer Program is dependent upon the allocation of Sisters Network resources to the Breast Cancer Assistance Program within Sisters Network annual budget. Sisters Network Board of Directors has exclusive determination as to those monies and resources.
- SELECTION PROCESS: The BCAP application, including the selection of the successful applicant is reviewed by the National Office. Sisters Network National Office reserves the right to decline a request, and/or partially grant a request based upon the allocation of funds to the program. REVIEWING OF THIS APPLICATION DOES NOT CONSTITUTE ANY PROMISE OR ASSURANCE BY SISTERS NETWORK (OR ANY OF ITS REPRESENTATIVES) TO AN APPLICANT REGARDING THE GRANTING OF THEIR FUNDING REQUEST.
- GRANTS OF RIGHTS, RESTRICTIONS ON USE: The information provided by applicant herein will only be utilized for Sisters Network Inc. consideration of your BCAP Application and our mailing list/marketing. Your utilized information will not be shared with anyone unaffiliated with Sisters Network. Should your request be granted, Sisters Network will not communicate with any third parties relating to your request without your prior consent. Sisters Network reserves the right to utilize your Breast Cancer Assistance Program experience to share with potential sponsors as well as the general public in order to promote the Breast Cancer Assistance Program to other women cancer survivors that could potentially participate in this program. Sisters Network reserves the right to terminate the Breast Cancer Assistance Program at any time due to budget restraints or mitigating circumstances.
- TIME FRAME OF PROCESS: The complete review/approval process takes approximately 30-45 business days from the date that Sisters Network® Inc. received the entire BCAP application package.
APPLICATION CLOSES SEPTEMBER 30, 2026 at 6PM (CST)
I affirm that I have read all of the above important information, and attest that the information provided by me in this application is true and correct to the best of my knowledge.
Applicant Signature*

Clear
Printed Name*
Date

MonthDayYear
Date
BREAST CANCER ASSISTANCE PROGRAM (BCAP)
- This program assists breast cancer survivors currently in active treatment and facing financial challenges.
- Financial Assistance is paid directly to third-party providers for utilities (gas-water-electric), mortgage or apartment rental.
- Please allow 30 - 45 days for review and processing.
Should be Empty:

HOUSTON-AREA SURVIVORS BREAST CANCER ASSISTANCE PROGRAM (BCAP) APPLICATION

(Spring/Summer 2026)

OPEN FEBRUARY 3, 2026 - SEPTEMBER 30, 2026

APPLICATION CLOSES SEPTEMBER 30, 2026 - 6PM (CST)

PERSONAL INFORMATION

FINANCIAL STATUS

BREAST CANCER STATUS

PHYSICIAN CONTACT

TERMS AND CONDITIONS

APPLICATION CLOSES SEPTEMBER 30, 2026 at 6PM (CST)

BREAST CANCER ASSISTANCE PROGRAM (BCAP)