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JustInTime Grant

Application

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  • Must be 18 years of age or older

  • Must have at least one dependent

  • Applicant or a dependent have a cancer diagnosis and are receiving active treatment

  • Must be experiencing financial hardship

  • Must be living in or treated in Minnesota

Eligibility

JustInTime Grant Application

Please select one of the following options:

applicant information

pATIENT information

If different from applicant (otherwise leave blank)
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Inform me regarding my application via:

MEDICAL information

HOUSEHOLD information

Financials information

What is your current housing situation?

Additional information

I declare that the information on this application is true and correct to the best of my knowledge. I understand that all applications will be reviewed on a case-by-case basis and final determination will be made by Justin Kukowoski Foundation. I hereby give my permission that this application and all information provided can be sent to Justin Kukowski Foundation and discussed with my health care professional. All information reviewed is confidential.

How did you hear about the JustInTme Grant

Thanks for submitting! Someone from the Justin Kukowski Foundationwill be in contact with you shortly.