To apply for assistance, you must currently be a resident of Jefferson County, WI and be in treatment for cancer. Applicants can apply up to three times per year. These grants can be used for rent/mortgage, utility payments (water, electric, and sewer), health insurance, or food and gas gift cards.
The application consists of 3 parts: an application form, authorization for disclosure of health information, and diagnosis verification form. Below is a button to view/print all of these forms; be sure to fully complete all of these forms before submitting an application.
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.