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F.A.S.T.™

Financial Assistance Screening Tool
presented by Sense of Security

FAST™ (Financial Assistance Screening Tool) is:

Directions for FAST™

  1. The F.A.S.T.™ form is located below.
  2. Answer 10 simple, anonymous questions about your financial and medical situation.
  3. FAST™ will process your answers and provide a list of agencies and organizations offering resources for which you may qualify, called the Financial Resources Profile. In addition, FAST™ also provides a detailed description of the programs, local contacts for additional information, web links when referring to a specific web site for additional information, and materials to apply for each program, when available.

Please do not hesitate to contact the office by telephone (303-669-3113) or email: Liz Miller if you require assistance using FAST™.

FAST™ does not require any identifying information. Sense of Security does not keep any information you enter into the FAST™ system and is unable to associate any data you may enter with your identity.

Although Sense of Security assists only breast cancer patients with non-medical financial aid, FAST™ includes resources providing assistance for a wide variety of purposes. Any Colorado resident seeking non-medical financial aid can use FAST™ to identify potential sources of aid.

F.A.S.T™ Form

Questions

note: 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?


           

Sense of Security makes no guarantee of any financial assistance from any agency or organization. Use of FAST™ does not guarantee any financial assistance from any agency or organization. FAST™ is a reference tool only. Sense of Security bears no responsibility or liability for FAST™ users and their results. Use of FAST™ guarantees that you, the user, have read, understand, and adhere to the FAST™ disclaimer seen below.

FAST™ DISCLAIMER

You acknowledge by the use of the Sense of Security FAST™ system (Financial Assistance Screening Tool) (the "Service") that you have read this disclaimer and understand and agree to the terms and conditions described herein.

Sense of Security FAST™ and the Sense of Security web site are protected by copyright as a collective work pursuant to U.S. copyright laws, international conventions, and other copyright laws. The contents are for your personal, non-commercial use only. Copying or storing of any content for other than personal, noncommercial use is expressly prohibited without prior written permission from Sense of Security. You agree not to reproduce, duplicate, copy, sell, resell, or exploit for any commercial purposes any portion of the Service, use of the Service, data obtained on or through the Service, or access to the Service.

Sense of Security maintains these databases to enhance public access to government and community benefits information. This is a service that is continually under development. While we try to keep the information timely and accurate, we make no guarantees. We will make an effort to correct errors brought to our attention.

Sense of Security and Sense of Security FAST™ cannot make decisions for its users nor does it determine actual eligibility for the programs contained within its databases. Sense of Security does not guarantee any eligibility for the programs contained within its databases.

All content is provided for informational purposes only. Sense of Security FAST™ may contain materials related to health or medicine, which are made available for informational purposes only, and are not intended to be a substitute for professional advice, diagnosis, or treatment. Sense of Security and Sense of Security FAST™ do not recommend or endorse any specific care facilities, tests, products, procedures, or opinions. ALWAYS SEEK THE ADVICE OF YOUR PHYSICIAN OR QUALIFIED PROVIDERS WITH ANY CARE QUESTIONS YOU MAY HAVE.

You agree to indemnify and hold Sense of Security and its affiliates, officers, agents, co branders or other partners, and employees harmless from any claim or demand, including reasonable attorneys' fees, made by any third party due to or arising out of your use of the Service, your connection to the Service, your violation of any terms or conditions of the Agreement, or your violation of any rights of another.

The documents in this database system contain hypertext pointers or links to information created and maintained by other public and private organizations. Please be aware that we do not control or guarantee the accuracy, relevance, timeliness, or completeness of this outside information. Further, the inclusion of pointers or links to particular items in hypertext is not intended to reflect their importance, nor is it intended to endorse any views expressed or products or services offered by the author of the reference or the organization operating the server on which the reference is maintained.

Any material downloaded or otherwise obtained through the use of the Service is done at your own discretion and risk and you will be solely responsible for any damage to your computer system or loss of data that may result from downloading any such material.

Sense of Security, the Sense of Security logo and marks, and other Sense of Security logos and service names are trademarks or service marks of Sense of Security. Without Sense of Security's prior permission, you agree not to display or use in any manner the Sense of Security logos, marks, trademarks or service marks. In addition, other third parties have their trademarked or copyrighted information within Sense of Security's site and these third party marks may not be downloaded from Sense of Security unless specifically authorized.

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