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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).

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

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Must be 18+ years of age.

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Please refer to application signature page for additional terms.

DOWNLOAD PDF APPLICATION HERE

NEXT STEPS

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Submit your application

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Online: Click BEGIN APPLICATION to complete online process

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

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

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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. 

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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.

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

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