How To Apply
- Living expenses and/or utilities expenses.
- Food and meal costs.
- Currently a cancer patient and receiving cancer treatment
Reside in or receive cancer treatment in one of the following cities:
- Lincoln, Nebraska
- Omaha, Nebraska
- Lawrence, Kansas
- Patient income must be equal to or below 250% of Federal Poverty Level (See Income Requirements)
- Must have been at least one year since you received assistance from STAC .
- You must have read and accepted the STAC Grant Restrictions.
- Patient Information : First and Last Name , Address , Date of Birth , Gender, Marital Status, Phone, Email address, Alternative contact , Phone number and Language Preference
- Provide One Proof of Income: Recent Tax Return, W-2′s, 2 most recent pay stubs, Medicaid verification (total household gross monthly amounts from all sources)
- Number of miles round trip to and from cancer treatment
- Physician First and Last Name
- Facility/Practice Name , Address, Phone Number and Fax Number
- Type of Cancer , Number of monthly visits and Length of cancer treatment