NOTICE: 5/8/2013- The program is temporarily closed and is not accepting applications at this time. Please see the right side of the page for update(s).
PLEASE READ THE ENTIRE PAGE CAREFULLY BEFORE APPLYING.
Assistance Program Purpose and Mission
The Assistance Program is made available to provide direct financial support for patients who are currently in treatment for breast cancer. Our hopes are to make the days less stressful by helping with expenses faced during that time.
Availability
Applicant must reside in one of the following states to be considered for assistance:
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Gift
Each applicant may apply once a year, up to two years total. The gift is given in the amount of $500.00 per year. (funds permitting). *The committee reserves the right to distribute assistance amounts based on funds available at the time.
Summary
- Assistance is made available to both men and women diagnosed with breast cancer through the Pink Ribbon Riders Patient Assistance Program.
- You must be currently undergoing breast cancer treatments to apply.
- The Assistance Program is a volunteer driven program that oversees applications submitted to Pink Ribbon Riders. The program is available due to the generosity of our donors and the volunteers that help with our fundraising events.
Policy
The policy is to guide the organization and its volunteers in processing requests from breast cancer applicants who have completed the application for assistance with Pink Ribbon Riders.
- The Assistance Program has the right to have “open and closed” periods. If there is a period where the program is closed, notification will be done on this page of the website. * The website will serve as the official notice for the Patient Assistance Program.
- The Assistance program is closed to new applicants during the last week of each month so we can process existing applications.
- Each applicant may apply once a year, up to two years total. The gift is given in the amount of $500.00 per year. (funds permitting). *The committee reserves the right to distribute assistance amounts based on funds available at the time.
Requirements for Assistance
- Applicant must be a U.S. citizen
- You must live in one of the states listed under “Availability”
- Part 1 and 2 of the application must be completed in full, including submitting all required documents.
*Original signatures, No faxes or copies of doctor signatures will be accepted.
Requirements to Apply – You MUST provide a copy of the following items
- Proof of US Citizenship. Copy of Birth Certificate or Passport.
- Copy of Drivers License or State Identification Card.
- A copy of your current income tax return – Page 1 showing proof of income.
* If you are not working, you must show proof of the household income.
* If you are only receiving social security – you must attach proof.
* If you are only receiving unemployment or medical disability – you must attach proof. - Copy of a medical bill related to your breast cancer treatment.
- A Doctor letterhead signed by treating doctor advising you are currently in treatment for breast cancer.
*Must be an original signature by the doctor, not a copy or fax copy.
When Will I Receive My Assistance
If you are approved for financial assistance, assistance will be mailed 3 to 4 weeks from the date we receive your completed application. So within a month from the time we receive your completed application, you should be receiving your assisance. Remember to consider time for the mail to get to us from where you live.
Important Facts
- You must be a US Citizen. Please do not apply if you can not prove that you are a US Citizen.
- Your application will NOT be processed or considered without the above requirements.
- On occasion testimonials may be required by applicant at the approval committee’s request.
- Policies and application criteria are reviewed periodically and amended accordingly.
- We can’t accept applications from other organizations. You must submit the Pink Ribbon Riders application.
- We can not process applications completed in a foreign language.
- We will contact you if we have questions about your application. Please do not call regarding your application.
TO APPLY
There are 2 Parts in the Application Process: You must be the patient to apply please.
- Part 1 – Online Form
- Part 2 – A downloadable form. You will be provide the link upon completing part 1
- Provide the 5 required documents listed above with your completed Part 2 and mail.
You will be prompted after completing Part 1 to access Part 2. There are 2 ways to access Part 2:
+ After clicking SUBMIT on Part 1, you will be given the link to Part 2. Copy/Paste the link into a browser window.
+ AND You will also receive an email with a click able link to Part 2, and can also access Part 2 this way.
Mail Part 2 and all required paperwork to submit your application:
Pink Ribbon Riders
Attn: Assistance Fund
5420 Beckley Road, Suite 334
Battle Creek, Michigan 49015
PRINT THIS GUIDE TO HELP YOU: CLICK HERE
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For a list of additional organizations who may be able to provide assistance: CLICK HERE
For assistance in Canada please see the Kelly Shires Foundation
Disclosures
- The Pink Ribbon Riders do have the right at anytime to make changes to the application process should there be a need from the Pink Ribbon Riders organization.
- If you are a doctors office or social worker with questions about our program, please contact us first before having patients apply. As a very small organization we would love to talk with you first.
- Pink Ribbon Riders is compliant with all HIPAA patient privacy requirements.
In order for the Pink Ribbon Riders to best help as many men and women diagnosed with breast cancer as possible the following items will be limited/capped.
- Lifetime financial assistance will not exceed $1,000.
- Once a year assistance is capped at $500.00.
The Pink Ribbon Riders is a small volunteer based organization. To date over 600 people diagnosed with breast cancer have been helped by the Pink Ribbon Riders.
