Request Assistance

To request assistance, please begin by completing the online form below. Once submitted, you will receive an email response within 24-48 hours containing the necessary forms, including the Application for Assistance and the Verification of Treatment.

Important: Please read the eligibility criteria and the additional information provided below BEFORE submitting your request for assistance.

Effective January 1, 2026, Families Raising Hope provides financial assistance one time per patient.

Patients who have previously received assistance from our organization are not eligible to reapply. This policy helps ensure we can support as many Arizona families as possible during active cancer treatment.

Eligibility criteria

An individual seeking financial assistance must satisfy ALL of the following criteria:

  1. Must currently be undergoing cancer treatment* (as defined below) at the time of application.

  2. Applicant must have a dire need* for financial assistance. Must be financially constrained due to necessity and be willing and capable of furnishing documented receipts/bills (e.g., medical bills, utility bills, mortgage payments, etc.).

  3. Must hold legal United States citizenship (Permanent Residency is not considered citizenship).

  4. Must currently reside in Arizona. Proof of AZ address is required. Applicant will need to provide a copy of their current AZ Driver’s License when the application is submitted.

  5. Must submit a completed application and a verification of treatment form. The verification of treatment form must be submitted by a medical provider/office. The person or caregiver requesting assistance can not submit this form.

Definitions:

Cancer treatment, as defined by Families Raising Hope, includes active medical therapies such as chemotherapy, radiation therapy, immunotherapy, or hormone therapy that are intended to cure, shrink, or slow the progression of cancer. Scheduled or planned surgeries, as well as post-surgical care when not accompanied by one of the therapies listed above, do not meet Families Raising Hope’s treatment eligibility requirements.

Dire Need is defined by Families Raising Hope as a need that describes an extreme and immediate situation, rather than simple inconvenience.

Note to Social Workers & Patient Navigators:

This form is for patients or their immediate caregivers to complete. Your patient is required to fill out this form as part of our application process. If they do not have access to a computer, please contact us directly: info@familiesraisinghope.org.

 Disclaimer:

Approval of financial assistance is not guaranteed for all requests. The discretion of Families Raising Hope applies to all requests based on our ability to provide requested funds.

Funds are limited and distributed based on need, urgency, and the availability of funds. Families Raising Hope reserves the right to limit or deny any funds based on the information provided. If false information is provided at any time during the process, FRH reserves the right to refuse a request.

All funds must be used for the purpose applied for and will be paid directly to the institution or organization providing the services funding is applied to. Families Raising Hope also reserves the right to offer financial assistance in the form of a gift card if deemed appropriate.

Any information provided to Families Raising Hope and its representatives will remain confidential and will not be shared with any agency or organization.

Request for Assistance Submission Form

Once this form is received, our team will follow up within 24–48 hours with an email outlining next steps and providing the required forms, including the application checklist, the application, and the Verification of Treatment form.