About Us: Financial Assistance

Application for $1500 in Financial Assistance

1. A doctors signature is required
2. Assistance to be used for cancer-related expenses.
3. Download the Application form below
4. Complete all fields on the form.
5. Fax form to: (765) 481-2262 -or- Mail to: 1208 N Lebanon St., Lebanon, IN 46052

Boone County Cancer Society will review this information and contact the person requesting financial assistance.

All information is strictly confidential and is for Boone County Cancer Society’s use only.