Program Application

Program Application Requirements

Hope Lives! provides free supportive services and products to help ease the side effects of breast cancer treatment for those in active treatment in Larimer or Weld Counties.

Do you qualify for our program?

If you fall into the requirements below, you might!

To be eligible, you must meet all three requirements listed below:

1. Active Breast Cancer Treatment: You must currently be in active treatment for breast cancer and receiving one or more of the following: chemotherapy, radiation, or upcoming surgery (lumpectomy or mastectomy).
2. Residency or Treatment Location: You must be a resident of Larimer or Weld County, or be receiving treatment in one of these counties.
3. Age: You must be 18 years of age or older.

If you meet all three requirements, please click the New Client Application button to fill out the form.

New Client Application Rules & Agreement