Mary Herczog Fund for Metastatic Breast Cancer Patients

Name*

First Last

Email*

Zip Code*

Have you been diagnosed with Metastatic Breast Cancer?*

Yes
No

Did you apply for and are awaiting Social Security Disability?*

Yes
No

Do you meet the household income of 500% or less of the federal poverty level based on last year’s federal tax return?*

Yes
No

We are sorry you MUST be a metastatic patient diagnosed under 40, and awaiting Social Security Disability, and have a household income of 500% or less of the federal poverty level, to qualify under The Pink Fund’s guidelines for additional resources. You must meet all 3 criteria for this additional funding. Please click here to return to The Pink Fund’s general funding pre-qualification guidelines to see if you qualify for general assistance. Click here to see if you qualify.

The Mary Herczog Fund for Metastatic Breast Cancer

The Mary Herczog Fund for Metastatic Breast Cancer

The Financial Side Effects of Cancer

Financial Toxicity

Job Loss

Bankruptcy

Impact on Savings

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