The Gynecological Cancer Awareness Project

The Gynecological Cancer Awareness Project

CanDo! is a project within GCAP 

NEED HELP OR HAVE QUESTIONS?

CALL  CanDO! at 505-289-6971

ALL WOMEN WITH ANY CANCER PLEASE COMPLETE ENTIRE FORM

By Clicking submit you agree to the following

I attest that the above information is correct and complete to the best of my knowledge. I further understand that if there are any significant changes to the information provided on this application, I have a responsibility to notify The Gynecological Cancer Awareness Project Patient Grant Program. Release of information: I authorize GCAP to request and obtain my confidential medical records and financial information if needed for The Gynecological Cancer Awareness Project grant review committee for the purpose of reviewing, finalizing, and carrying out the disbursement of patient grants, as well as, patient navigation. This confidential information will not be released to any other parties. 


GCAP works IN COLLABORATION WITH THE CanDO! Project. (Cancer Distress is Over). The CanDo! project is a program developed by GCAP to provide navigation services to community support resources and educational opportunities for women with cancer.


When this form is submitted you agree to have a CanDo! patient navigator contact you, to provide other community resources

that may be available to help you Free of charge. 

Call CanDO! at 505-289-6971

Patient assistance Application fROM gcap and the cando NAVIGATION project              


GCAP has connections to many patient assistance resources and agencies FOR WOMEN WITH ANY CANCER via the CanDO! project (Cancer Distress is Over). We assess different areas of distress to be able to connect you to ALL the possible resources you may need to decrease your distress.

PLEASE NOTE THAT WE CAN ONLY PROVIDE FINANCIAL ASSISTANCE TO GYNECOLOGICAL CANCER PATIENTS IN THE
STATE OF NEW MEXICO, NE ARIZONA AND EL PASO, TEXAS.

IF YOU DO NOT HAVE A GYNECOLOGICAL CANCER PLEASE FILL OUT THIS FORM REGARDLESS TO BE CONNECTED TO OTHER FINANCIAL RESOURCES VIA THE CANDO PROJECT

GynecologicaL cancer patients may request help with rent or a mortgage payment, child care, transportation, groceries and other daily expenses. Funds also help rural patients pay for lodging or transportation costs including a gas card to get treatment in Albuquerque. Funds go exclusively toward non-medical expenses and are paid directly to a third-party payee (Mortgage Company, landlord, utility company, Phone Company, etc.). Television cable bills and bills related to hospital copayments or other medical bills will will not be accepted.

​All funding is based on need and available GCAP funds. Should a grant be approved, a check will be issued only to a third party, never to the patient.

*Grants are limited to one per year and are capped based on a needs assessment and available funds. GCAP may only distribute one grant per patient each calendar year. If you receive a grant in June 2014, you will not be eligible to receive another grant until June 2015. If more funds are needed we do have the ability to connect you with other potential funding sources.


Directions

1. Please complete form below

 

2. After submitting form below you will be contacted by GCAP to discuss your need and how we can help.


3. After GCAP talks with patient, please submit all requested documentation and/or copies of bills to be paid to:

      GCAP 

      7007 Wyoming NE Suite D3

      Albuquerque, NM. 87109

   Or Scan and Email to:

      janet.longhurst@comcast.net

   Or give paperwork to social worker who can forward to our office for you.