The Breast Cancer Assistance Program (BCAP) provides assistance to women facing financial challenges after diagnosis. This program provides free mammograms and financial support for: medical related lodging, co-pay, office visits, prescriptions and transportation.
The form below must be completed and submitted with the REQUIRED SUPPORTING DOCUMENTS (i.e., medical bills, rent receipt, utility bill, etc.). Upon completion and submission of the form, the application process takes a minimum of 7 business days, incomplete application will be returned and will delay any decision regarding assistance.
If your application is approved you are required to do the following:
If these requirements are not met you will be ineligible to apply for future funding.
It is our goal to assist you financially during your journey. Sisters Network® Inc. (SNI) is a leading voice and only national African American breast cancer survivorship organization in the United States. Our purpose is to save lives and provide a broader scope of knowledge that addresses the breast cancer survivorship crisis affecting African American women around the country.
Valarie C. Worthy, President Sisters Network Triangle NC
BREAST CANCER ASSISTANCE PROGRAM (BCAP) APPLICATION
If approved, financial assistance payments may be made directly to the Provider.
Submission of this application does not imply nor guarantee approval of Financial Assistance
PLEASE COMPLETE THE ENTIRE APPLICATION(PRINT CLEARLY)
*Denotes a required field