The Pink Purse mission is to provide emergency assistance to underserved breast cancer patients in financial crisis while undergoing active treatment for a breast cancer diagnosis. This emergency fund provides assistance for critical non-medical essential household expenses.

Active treatment for the purposes of the Pink Purse is defined as the period after a positive breast cancer diagnosis has been made and during which therapies are being administered, including surgical procedures to remove the cancer (ie. single or bi-lateral mastectomy, lumpectomy), chemotherapy or radiation. Active treatment does not include long-term hormonal therapies such as Tamoxifen or an Aromatase Inhibitor.

Pink Purse Funds considers the following but not limited to as Critical Non-Medical Household Expenses:

• Utilities (i.e. electricity, heat, gas and hot water)
• Phone and Cable
• Transportation to and from hospital visits and treatment centers to include Uber gift cards, car loan payments and car insurance premiums
• Rent or Mortgage (At this time, we are accepting requests from Connecticut and Long Island, NY)

* Please note Pink Purse does not pay directly to individuals but to the service provider

For All Applicants:

• All applications must include the required documentation listed on this application in order to be eligible for funding.
• Incomplete applications will not be considered for review.
• Patient's household income should be 300% or less of the FEDERAL POVERTY LEVEL based on last year's federal tax return

1. A completed application signed by a Nurse Navigator, Hospital Social Worker or 501c3 Administrator.
2. A signed letter from a doctor on hospital letterhead confirming breast cancer diagnosis/active treatment, including date of latest treatment.
3. A signed letter from a Nurse Navigator, Hospital Social Worker or 501c3 Administrator verifying the patient qualifies for financial assistance.
4. A billing statement dated within 30 days of this application and must relate to the patient's place of residence.
5. A current lease or Proof of Residency Formis required for rent requests (for CT and Long Island, NY residents ONLY at this time)

Please note: At this time, Connecticut and Long Island, NY residents may receive up to $1,000 in a twelve month period and all other patients may receive up to $500 once during a twelve month period. At this time, applications can only be accepted in English.

For all social workers, you may use these documents to determine financial need. (There is no need to send these documents to Pink Aid.)

Examples of acceptable documentation for confirmation of annual income:
• Most Recent Federal Income Tax Return
• Pay stubs
• Most recent W-2 or 1099
• Social Security Award Letter
• Unemployment Statement
• Workers Compensation Award Letter
• Letter from sponsor/family financially supporting patient
• Verification of extenuating circumstances that account for sudden loss of income

Financial Need:
All applicants residing outside of the state of CT and Long Island, NY, household income should reflect 300% or less below Federal Poverty Level based on last year’s federal tax return. A patient will be deemed to have financial need based on the Federal Poverty Levels (“FPG”).