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.

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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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