Apply for Financial Assistance

When you need help with cancer-related costs, turn to The APG Foundation. You’ll find financial assistance programs through which you may receive up to $3,000 per year to help cover the cost of medications and other related services. Let the APG Foundation ease the financial stress that comes with cancer treatment. We’re here for cancer patients who have no other readily available means of payment for medications and related items.

Qualifying Expenses

Funds can be used by patients and their families walking through their cancer treatment journey to assist with costs of:

Medications
Compression sleeves and stockings
Prosthetics, wigs, mastectomy bras
Meals
Groceries
Massage, Reiki, acupuncture and other complementary services
Gas Cards
Medicinal CBD products
Utility Bills
Rent
Transportation

How to Get Financial Assistance

To apply for financial assistance, follow these steps:

Choose how you would like to apply for reimbursement:

Online: Complete the online application below, following the instructions within the application, OR
Paper and mail:

Download and print the Financial Assistance Application form.
Complete the form and sign it.
Mail it to The APG Foundation, P.O. Box 1248, Cedar Rapids, IA 52406-1248 with copies of your receipt(s) if available, showing the date, applicant’s name, name of medication, item or service and the amount paid.

You only need to submit an application once. For recurring purchases, you can submit the receipts by mail or email. If you send receipts by email, for security purposes please attach them to an email generated from the Contact Us page.

Applicant

Name: (required)

Street Address: (required)

City: (required)

State: (required)

ZIP: (required)

Telephone: (required)

Email address: (required)

Patient Birth Date (mm-dd-yyyy): (required)

Physician Information:

Physician Name:

Office address:

How did you learn about APG Foundation?

Required Supporting Documents

Please provide receipts outlined below.

You may submit digital copies (PDFs or images) with this form by clicking on "Choose File" below, or you may send print copies to APG Foundation, P.O. Box 1248, Cedar Rapids, IA, 52406-1248.

Receipt(s) that include the date, applicant’s name, name of item or service purchased and the amount paid.

Consent & Authorization

By submitting this form:

I attest that to the best of my knowledge the information provided is accurate.
I affirm that I have no other readily available means to purchase prescribed medications and prostheses.
By submitting your information electronically you acknowledge that you are submitting protected health information (PHI). Please be aware that email communication can be intercepted in transmission or misdirected.
I understand that information provide here will only be used by the APG Foundation for processing financial assistance requests and will not be provided outside the APG Foundation.
I agree to provide further information if needed.

I Agree

Financial Assistance