Download Application
Patient or providers must print the application and mail the completed application with income verification documents to the foundation office. Heartland Cancer Foundation will review the application on a rolling deadline to approve or decline your submission. Once a determination has been made, you will be notified by mail. Please make sure you have read and understand the Grant Restrictions, HIPPA, and Income Requirements.
To be eligible you must meet the Income Requirements and reside in one of the following counties:
Nebraska: Boone, Butler, Cass, Fillmore, Gage, Jefferson, Johnson, Lancaster, Nemaha, Otoe, Polk, Pawnee, Richardson, Saline, Saunders, Seward, Thayer and York.
Kansas: Brown, Marshall, Nemaha, Republic and Washington
Please note that to receive transportation assistance, you must travel at least 15 miles round trip to your treatments.
To be eligible you must meet the Income Requirements and reside in one of the following counties:
Nebraska: Boone, Butler, Cass, Fillmore, Gage, Jefferson, Johnson, Lancaster, Nemaha, Otoe, Polk, Pawnee, Richardson, Saline, Saunders, Seward, Thayer and York.
Kansas: Brown, Marshall, Nemaha, Republic and Washington
Please note that to receive transportation assistance, you must travel at least 15 miles round trip to your treatments.