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How Do I Get Help?
We Are Here For You
To qualify for financial assistance, you are a resident of Jefferson County, WI and in treatment for cancer. Applicants can apply once per calendar year. Current grant amounts range from $1,500 per application; this compensation is subject to funds available. These grants can be used for rent/mortgage, utility payments (water, electric, and sewer), and gas and grocery gift cards.
Below is your application to download and print. If you do not have a printer:
- At your next oncology appointment, you can ask your care team for the application; some clinics may already have them available. Your care team may also be able to help complete the "Verification of Diagnosis" section of the form.
- You can email us at contact@jeffersoncountycancercoalition.org and ask us to mail you a blank application.
Application Form
When you have completed all of these forms please mail them to our PO Box at:
Jefferson County Cancer Coalition, P.O. Box 448, Fort Atkinson, WI 53538
If you have any questions or concerns you can CONTACT US.
Approved applications are identified by a unique client number to ensure confidentiality and only the treasurer is aware of the name and private information of the applicant.
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