---

APPLICATION TO RECEIVE FINANCIAL SUPPORT FROM C.A.S.T.

Our goal is to work through doctor and oncologist offices, giving application to distribute to those most in need. If you are interested in applying for financial support from C.A.S.T., please fill out the application to the right. 

After receiving completed application, we will use fundraisers and events to provide support in the form of:

• Prescription drug coverage
• Gas cards
• Utilities (gas, electric, water, etc.)
• Payments for cancer-related medical bills
• Insurance deductibles

We also welcome personal referrals of patients and physicians. We will contact the necessary personnel for qualifications.

Please fill out this application as accurately as possible. If information is not accurate, eligibility will be denied.

*You will be required to submit a pay stub for your income and spouse's income, so please provide this information as accurately as possible.

Please note that every 6 months, applications must be re-submitted and approved by the C.A.S.T. Board in order to continue receiving financial support. 

If you would prefer to fill this form out on paper, please download the application below and send completed for to:

cast_application_2021.docx


C.A.S.T.
1333 Burd Ave NE
Massillon, OH 44646
​

Questions? Click here to contact C.A.S.T.