Cover Letter and Application
Grant Application and Grant Request Verification Forms
Qualifications (effective January 1, 2013, through December 31, 2013)
- Grant applicants must have a cancer diagnosis and be currently receiving medical treatment for cancer.
- Grant applicants must be a Colorado resident or receiving treatment in Colorado.
- Grant applicants must be 18 or older.
- Annual household income cannot exceed 175 percent of the federal poverty guidelines outlined below.
Gross Monthly Income
Add $557 for each additional person.
- All applications must be accompanied by a completed Grant Request Verification Form.
- Applications will not be considered complete without a verification of a cancer diagnosis and current treatment from a healthcare professional (physician, nurse, social worker, or patient navigator).
- Application may be downloaded below or you may call or e-mail to have an application mailed or faxed to you.
- Only completed applications will be reviewed.
- Applications that are incomplete will be placed on hold. We will contact you to let you know what is needed to complete the application.
- Applications may be completed by patient with help from any healthcare representative.
- Applications will be reviewed on a monthly basis.
Mail completed applications and supporting documents to:
Rocky Mountain Cancer Assistance
P O Box 6625
Denver, CO 80206
- Applications may also be faxed to us at: 888-600-4452
Click the above link to open it or right click to download the file. The application is a PDF. If you do not have Adobe Acrobat Reader, please click on the icon below to download the free software.
Adobe Acrobat Reader download icon: http://www.adobe.com/products/acrobat/readstep2.html
Applications are reviewed by the RMCA staff. Incomplete applications will not be considered and will be placed on hold until complete.
If an applicant is approved for assistance, the applicant will be notified by phone or e-mail regarding the amount of the assistance.
Financial assistance checks are made payable to the vendor and sent to the applicant for mailing to the vendor.
RMCA's financial assistance typically pays for the most basic of needs: food, housing, utilities, transportation, and health insurance premiums or COBRA payments.. This support helps reduce the stress of maintaining daily routines during treatment and contributes to retaining dignity and quality of life.
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Save on Shaving Razors While Supporting Cancer Assistance with ShaveMOB
Rocky Mountain Cancer Assistance is partnering with ShaveMOB.com to support Breast Cancer Awareness and Movember by raising money to benefit cancer patients and their families receiving treatment in Colorado. ShaveMOB pledged to donate $0.25 per order throughout the months of October and November to Rocky Mountain Cancer Assistance.
After having success with the Pink Razors for Pink Ribbons program in October, ShaveMOB expanded the program through the end of November to focus on men’s health and prostate cancer support. This program is complemented with a cheeky ShaveMOB “Moustache Monocle” created for those who cannot or will not grow facial hair. ShaveMOB’s effort will be capped off with a Photo Booth effort on November 30 in Denver’s Larimer Square where passersby can show their support for cancer awareness and have their photos taken with the Moustache Monocle or other props.
Zach Randall, ShaveMOB CEO, said "At ShaveMOB, we stand for the benefits that our customers have come to realize: saving money, time, and reducing your environmental impact. But customer or not, we’re also about making a stand for the benefit of humanity. Joining the fight against cancer is one of them. We are hopeful we can help make an impact."
After a lengthy selection process, ShaveMOB chose to partner with RMCA as the company felt it could drive the most measurable impact at the local level. Grace Castellanos, Executive Director of the Colorado-based non-profit, said “RMCA is very excited about the prospect of partnering with ShaveMOB. Since 2000, we’ve provided over $3 million in financial assistance to more than 5,000 cancer survivors, and programs like this will help continue our mission.”
Visit ShaveMOB.com and support cancer assistance while saving 70% on shaving razors.