Are you in active treatment?
Active treatment is defined as the period of time after a positive breast cancer diagnosis has been made, and during which therapies are being administered, including surgical procedures to remove the cancer (e.g. single or bi-lateral mastectomy, lumpectomy, axillary dissection, or sentinel node biopsy), chemotherapy or radiation. Active treatment does not include reconstruction surgeries or long-term hormonal therapies.
Has your household working income decreased?
Did your spouse/partner experience a loss of income due to your breast cancer diagnosis?
Please email a copy of the following documents to info@diannarasha.org.
Name of applicant must be included in subject line.
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A Copy of your Driver's License or state ID. The address on your ID must match the address you enter when applying.
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HIPPA Privacy Authorization Form.
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A signed and dated letter on letterhead from your Oncologist that verifies your breast cancer diagnosis and outlines your current active treatment plan. This letter may also be from your Professional Patient Navigator or Nurse Navigator. Please be sure to provide email address for this person on your HIPPA Privacy Authorization Form.
