How Do I Get Help?

You may apply for funds to help with added expenses while going through the cancer fight. Before sending the application, please read the directions for completing the packet. The necessary forms are available to download in pdf format.

Directions for Completing the Packet

1)Application Form
  • All areas must be completed (except those marked GCCC Rep)
  • Please give as much information as possible.
2)Authorization for Disclosure of Health Information
  • This form must be filled out by the applicant before seeing your doctor.
  • The doctor must see this form and verify your diagnosis.
  • Leave a completed copy at the doctor's office to have placed in your medical record.
3)Diagnosis Verification Form
  • This form must be completed by your doctor.
4)All three forms must be returned to the GCCC board to have your request acted upon.

Our mission is to assist cancer patients in the greater Grant County WI area. As applications are submitted, each will be given a case number, allowing as much confidentiality as possible, with only one board member knowing the applicant's name. We are dedicated to being fair to everyone and it is our hope to be able to meet the needs of everyone that applies.

Applications are verified and final approval is authorized at the earliest board meeting following verification. The board meets the second Wednesday of each month.

Application Forms and Directions for Completing the Packet

Application Form Acrobat File
Authorization for Disclosure of Health Information Acrobat File
Diagnosis Verification Form Acrobat File
Directions for Completing Application Packet Acrobat File

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