Get help

---

Do you reside in Southeast Ohio? 

Are you in treatment for breast cancer?  

Are you stressed about your financial situation?   

We want to ease the stress by providing emergency relief and short term help! 

Take these steps to get started:  

• Detail your needs on the form below  
• We will contact you for additional information  
• Send us a copy of your bill   
• We will meet to approve part or all of the funds up to $500 max during your treatment (this could take up to two weeks) 
• Funding goes directly to the company/organization you owe   

By submitting your information, you agree to the statements below.     

1. I understand and recognize that the Ohio Pink Ribbon Fund is a nonprofit corporation which has received 501(c)(3) recognition.    
2. The fund was established to benefit people diagnosed with breast cancer who demonstrate a financial need, and live within the service area of Athens, Gallia, Hocking, Jackson, Meigs, Morgan, and Washington counties.    
3. The fund was established to provide emergency assistance with health or living expenses.      
4. The organization will grant funds on an equal opportunity basis to survivors in Ohio and Wood County West Virginia, as long as funds exist, without regard to the applicant's sex, race, color, religion, creed, ethnicity, marital status, or sexual orientation. 

I certify the information on the application below is true and accurate and that purchase of goods of services which I have requested would cause financial hardship for me and my family. By entering my information below, I hereby grant and give permission for someone from the Ohio Pink Ribbon Fund to contact me. I also understand that if I knowingly enter false information, I could be subject to punishment to the fullest extent of the law.