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CLIENT APPLICATION

DO I QUALIFY?

 

You must be in active treatment for breast cancer by receiving one or more of the following: chemotherapy, radiation, upcoming surgery (lumpectomy/mastectomy).

Must be a resident of or be receiving treatment in Larimer or Weld County.

Must be 18+ years of age.

Please refer to application signature page for additional terms.

NEXT STEPS

Submit your application

Online: Click BEGIN APPLICATION to complete online process

E-mail: Click DOWNLOAD APPLICATION and share to info@hopelives.org

Mail: Click DOWNLOAD APPLICATION, print, complete and mail to 2627 Redwing Rd, Suite 210, Fort Collins, CO 80526

Once your application has been received, our staff will be in touch to schedule an in-person orientation. Process typically can take several weeks from start to finish. 

Finished with treatment, but still need help?

 

Click here to download a list of providers who specialize in clients with your unique needs and for a list of additional resources.

Also, check our partnership with Soul Agency for the Survivor Speaker Series offering for clients just like you!

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