Apply for the Feeding the Hungry

Up to $200 a month for up to 3 months to help cover your out-of-pocket expenses during treatment.

Eligibility Requirements

Adult (18+) with an active Providing meals at Holidays diagnosis
Currently in active treatment
Experiencing financial hardship due to increased expenses and treatment costs
U.S. resident

Personal Information

First Name

Last Name

Email Address

Phone Number

Address

Street Address

Apartment, Suite, etc. (optional)

City

State

ZIP Code

Program Information

Providing meals at Holidays Diagnosis

Please provide your diagnosis type and stage if known.

Current Providing meals at Holidays Treatment / Service Type

Describe the type of treatment or service you are currently receiving.

Treatment Facility Name

Cook Name (optional)

Annual Insurance Reset Date

The date your deductible and policy resets each year.

Treatment Start Date

Expected Treatment End Date (if known)

Verification Required

If your application is approved, we will need verification of your treatment from your doctor or treatment facility. Our team will contact you with details on how to provide this authorization.

Financial Need

Please describe your current financial need

Be specific about copays, deductibles, transportation, nutritional needs, household expenses, or other out-of-pocket costs.

What expenses would this grant help cover? (check all that apply)

Treatment and doctor visits Medications Lodging near treatment facility Food / Nutritional needs Utilities (electric, water, phone) Other essential needs

Consent & Acknowledgment

I certify that the information provided is true and accurate to the best of my knowledge. I understand that Sample non Profit may verify my treatment status and that providing false information will disqualify my application. * I consent to being contacted by Sample non Profit regarding my application and for follow-up purposes.

Applications are typically reviewed within 5-7 business days.