Scholarship Application

Cancer is expensive.

If you need help, we want to make it easier for you to attend one of our SCC Patient Programs.

Although scholarship amounts vary and are completely dependent on donations to SCC,
we try out best to assist.
If you feel you need financial assistance to attend, please fill out the application below and we will seek help and show you ways you can seek help to attend as well.

Please note: If our funding amounts are not sufficient to handle your needs, these amounts can not be reserved or held, but are passed along to the next person on our list needing assistance.
Thank you!

Now let's get started!

* Indicates required field

Name *

First

Last

Age *

Email *

Physical address *

City, State, Postal Code *

Home Phone *

Diagnosis *

Cell Phone *

Date of Initial Diagnosis *

Any Additional Health Problem? *

Occupation *

Annual Income *

Spouse or Support Person (We do ask when possible that you bring a support person) *

Support: Age and Phone number *

Insurance company and number *

Please explain your financial situation and the need for assistance *

Please explain how you hope to benefit from the SCC Program *

Submit