Apply

When applying for assistance, Please email a copy of the following documents to

info@diannarasha.org.

Name of applicant must be included in subject line.

• A Copy of your Driver's License or state ID. The address on your ID must match the address you enter when applying.

• HIPPA Privacy Authorization Form. You can download this form below.

• 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 yzour HIPPA Privacy Authorization Form.

• A letter detailing your story and how the D.R.F. can assist you.

You can also download our application checklist below.

• Young women ages 13-35

• Patients must be in active treatment for their breast cancer diagnosis.

• Patients must be actively undergoing treatment throughout receiving assistance.

• Patients undergoing only reconstruction are not eligible.

• Patients only receiving long-term hormonal therapies are not eligible.

• You must provide proof of a current diagnosis via a signed, dated letter on official letterhead AND our medical information form, both completed by one of the following: Oncologist, Licensed Social Worker, Patient Advocate, or Nurse Navigator.

• The Dianna Rasha Foundation does not discriminate on the basis of race, religion, age, nationality, gender or ethnicity.

The Dianna Rasha Foundation provides assistance towards self care, including beauty, wellness, and mental relaxation in order to help young women ages 13-35, who are currently undergoing active treatment for breast cancer, to look & feel their absolute best.