FORMS

What is Traci’s Hope?

Traci’s Hope is a not-for-profit organization dedicated to help people diagnosed with breast cancer.  We know how this disease can throw your life into a tailspin (taking care of family, home, job and other responsibilities).  It is Traci’s Hope’s goal to offer a way to relieve some of the stresses and demands of everyday life.

Details and Eligibility Requirements

Traci’s Hope will provide funding for:
1. Medical costs and supplies related to a breast cancer diagnosis
2. Utilities
3. Housecleaning
4. Rent/Mortgage
5. Transportation
6. Childcare
* Other needs may be considered upon request.

You are eligible to apply to Traci’s Hope if :
1.  You’ve been diagnosed with breast cancer (including recurrence or metastasis)
2.  You are in the midst of breast cancer treatment (surgery, radiation, chemotherapy) or it has been less than a year since your treatment was completed.
3.  You live in Bradford, Broome, Susquehanna or Tioga County.

To apply, you will need to :
1.  Fill out an application form for Traci’s Hope.  This can be downloaded from this website.
2.  Get confirmation of diagnosis from your doctor.
3.  Fill out and sign a release form. Can be downloaded from this website.

Limitations

Limit for individuals are $1,000/year, with a lifetime maximum of $2,500.

Overall funding limitations will impact amount available to clients and decisions will be made regarding funding requests accordingly.  Decisions will be made by committee.

Click the link below to download the proper forms needed in order to apply for assistance. You will need to print the forms out and follow the included instructions.

CLICK HERE FOR THE PAPERWORK