Eligibility

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1. You must 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
2. You must meet the Foundation’s FINANCIAL NEED ELIGIBILITY CRITERIA
3. You must travel at least 15 miles round trip to your cancer treatments to be eligible for gas assistance

Grant Restrictions

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• The Foundation may ask at any time for further documentation to support a patient’s eligibility, including after any grant has been extended. Any falsification of an application is fraudulent and subject to potential criminal penalties and civil damages. 
• In all cases, the patient will already be under the care of a physician with a treatment regimen in place at the time of application. 
• The Foundation will make no referrals or recommendations regarding specific providers, practitioners, suppliers, products, or plans. 
• Patients will not be informed of the identity of specific donors. 

• The determination of a patient’s financial qualification for assistance will be based solely on his or her financial need, without considering the identity of any of his or her health care providers, practitioners, suppliers, products, or insurance plan; the identity of any referring party; or the identity of any donor that may have contributed for the support of the patient’s condition. 
• Assistance will be based upon a reasonable, verifiable, and uniform measure of financial need that will be applied in a consistent manner. 
• Patients are free at any time to switch providers, practitioners, suppliers, or products without affecting their continued eligibility for financial assistance. 
• Medicare beneficiaries are free to switch insurance plans when permitted by the Medicare program, without affecting their eligibility for assistance.