- We are in the process of creating a new format to the Pink Ribbon Riders Patient Assistance Program which will be announced in fall of 2015.
- We are currently not accepting new applicants to our program s as we have an overwhelming amount of applications that we are currently working on. Until those applicants complete their applications we can not reopen.
- If you are a person that put your name on the waiting list during September, please watch your emails during the month of October for further details.
- *Please do not email asking when we will be accepting applications again. All nurses and cancer centers that are in our system will receive an email notice when we make the announcement.
- * If you are a patient looking for help, please check back in mid October.
Assistance Program Purpose and Mission:
The Assistance Program is made available to provide emergency direct financial support for men and women currently diagnosed with breast cancer patients in current treatment. (Chemo, radiation, surgery or awaiting surgery with emergent needs to cover costs that have caused stress due to the fight against breast cancer.)
The program gives financial support in the form of a gift card to patients in states in which the Pink Ribbon Riders fundraise in through their volunteers and donor support. The funds stay in the states in which we fundraise in. The mission and the program was created to help those in need by people helping people right in their own communities.
Our hopes are to make the days less stressful by helping with expenses faced during that time.
Availability to apply, you must meet all 3:
#1 – You must reside in one of the states :
Minnesota, New York, Wisconsin, Minnesota, Michigan, Colorado, North Dakota
- Special Notes
- New York- We do not accept NYC area ( Manhattan etc) or Long Island.
- Michigan -Closed until further notice. We have had more patients than we could fundraise and are working hard to find funding for the future
#2 – Be a US Citizen and be able to provide documentation.
#3 – You must be in “Current” treatment for breast cancer receiving : Chemo, radiation, surgery or awaiting your first surgery.
The Gift of financial assistance:
- The gift of assistance is made available for both men and women in current treatments for the diagnosis of breast cancer.
- Each applicant may apply once in a lifetime.
- Please see all requirements listed on this page to see if you qualify before applying. And do not apply until you have gathered all needed documents.
- The gift is given in the amount of $500.00 per year in the form of a gift card. (funds permitting)
- The committee reserves the right to distribute assistance amounts based on funds available at the time. Just because you apply does not mean you will be accepted. You must meet all the requirements and proof of eligibility.
- To be considered you must fill out the Pre application screening form to be considered to apply.
Summary of the Program:
- Assistance is made available to both men and women diagnosed with breast cancer that are in IMMEDIATE NEED of financial help through the Pink Ribbon Riders Patient Assistance Program.
- You must be currently undergoing breast cancer treatments (chemo, radiation, surgery) or awaiting surgery to apply.
- The program is designed for when you are just diagnosed and have lots of costs due to your diagnosis.
- 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.
Requirements for Assistance:
- Applicant must be a U.S. citizen no exceptions.
- You must live in one of the states listed under “Availability”.
- You will be required to fill out a PRE Application form.
- Once we have reviewed your pre application form we will notify you by email for the following steps:
- Part 1 and 2 of the application must be completed in full, including submitting all required documents all at once
*Original signatures, No faxes or copies of doctor signatures will be accepted.
- Must complete Part 2 within 30 days of completing Part 1. Meaning Part 2 must come complete with all items mailed together. IF you forget one item you are incomplete and will not be considered.
REQUIRED ATTACHMENTS that you send in with Part 2: You MUST provide a copy of the following items: Mail ALL items together. Your application will be considered incomplete if not all mailed together. Suggestion- Do not start your application until you have collected the items below.
- Proof of US Citizenship. Copy of Birth Certificate or Passport, or US Naturalization certificate.
- Copy of valid Drivers License or State Identification Card.
- A copy of YOUR current income tax return – Page 1 showing proof of your income.
* If you are not working:
* If you are only receiving social security – you must attach proof of your social security amount.
* If you are only receiving unemployment or medical disability – you must attach proof.
- Copy of a medical bill related to your breast cancer treatment. – If you do not have a medical bill related to your treatment because you are covered by insurance, please provide something that shows why you are in financial need. Example: Utility bills that are past due. Rent or mortgage bills that are past due. Please, we need you to tell us WHY you need the gift form Pink Ribbon Riders.
- 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 or a prescription pad or medical records.
- Must have your diagnosis date on it.
- Must have what treatment you are receiving (chem, radiation, surgery or awaiting surgery & the date of surgery)
- 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 or write us regarding your application.
There are 3 Parts in the Application Process:
You must be the patient to complete these steps.
- Complete your pre application screening form. Request are reviewed during periodic review sessions.
- Then if accepted to apply, Part 1 will be an Online Form we will email to you once you have been accepted for consideration
- Part 2 – A downloadable form. – You will be provided the link upon completing part 1 by email. DO NOT reproduce part 2 for others, changes might have been made.
- Provide the 5 required documents listed above with your completed Part 2 and mail to address below.
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
* We are currently not accepting applicants at this time. Public notice will be made on this website page when we are reopened.
MICHIGAN – CLOSED until further notice
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 or thru an official email from PRR. If you are a cancer center nurse or social worker, please email us thru our CONTACT US page to be put on our approved referral list. ( This will guarantee you notices and updates from us)
* The PRR website will serve as the official notice for the Patient Assistance Program.
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.
- Each applicant may apply once in a life time. 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.
- The assistance program has the right to have “open and closed” periods. If there is a period that is closed, notification will be done on the upper right side of this page.
- This website wills serve as official notice of the patient assistance program.
– The Pink Ribbon Riders have the right at anytime to make changes to the application process should there be a need.
– 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.
– Once a year assistance is capped at $500.00.
– As of June 2015, Pink Ribbon Riders is not accepting applications in the state of Michigan due to lack of funding. We will make an announcement on this website page if and when we maybe able to open the program again. Until further notice this is our public announcement.