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SOS Application

The Sense of Security Application is available in Adobe Acrobat format. You MUST have Acrobat Reader to view and print the application. This is a free software program that takes a few minutes to download, just click on the link below.

If you have not read the application criteria, please do before downloading the application.

 

Questions
All fields are required

  1. What is your age?


  2. What Colorado County do you live in?


  3. What is your monthly total household income as of today?
    $   (round to nearest dollar)

  4. How many people live in your household?


  5. Do children under the age of 18 live in your household?
    Yes No


  6. How many months do you expect to be in treatment?


  7. Is your physical mobility severely limited due to your cancer diagnosis or treatment?
    YesNo

  8. What is the status of your employment?


  9. Are you in danger of losing your housing?
    YesNo

  10. Are you an undocumented worker?
    YesNo

  11. At which facility are you receiving treatment?


           
application criteria
application - sustained assistance program

application - emergency, transportation or household funds

FAST™ - Financial Assistance Screening Tool
program faq
statistics
my story
financial resources listing-alphabetical
 
 
We seek to provide a sense of security from financial hardship and enhance the quality of life for breast cancer patients in treatment

Sense of Security, Inc. - 8774 Yates Drive, Suite 330, Westminster, Colorado 80031
Voice: 303-669-3113 - Toll-free outside 303/720-area codes:: 866-736-3113
Email: info@senseofsecurity.org

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