Patient Assistance

Go Jen Go’s Patient Assistance program helps individuals facing the financial burden of a breast cancer diagnosis. 

Eligibility Criteria:

  • Diagnosed with breast cancer
  • Reside or receive treatment in the Greater Charlotte, North Carolina area
  • Currently in active treatment

Assistance Overview:

  • Grants will be awarded based on financial need for assistance with daily living expenses including:
    • Housing (Mortgage, Rent, Hotel costs during treatment)
    • Utilities
    • Transportation (to and from treatment)
    • Groceries/Necessities
  • Medical expenses are not eligible for funding
  • Grants may be single allocation or monthly stipends based on the need
  • A letter confirming the patient is currently being treated for breast cancer and the current stage of breast cancer will be required for the application to be complete. This letter may come from a medical provider, social worker, or patient navigator.

If you are in need of assistance, please complete the form below or you may download and fill out this form. (PDF) and then email it to us.

Please allow three weeks for us to review the information and get in touch with you.

 

1 Step 1
Race/EthnicityOptional
Are you currently undergoing active treatment?surgery, chemotherapy, and/or radiation
Employment Status
If not currently working, describe reason:Select all that apply
Are you working with a Social Worker or Patient Navigator?
May we contact your Social Worker or Patient Navigator on your behalf?
Please select the form of assistance most helpful in your current circumstancesSelect one
What is your Primary financial need right nowSelect one
I hereby attest that the information provided in this application is true, accurate, and complete and that I am the person who is the subject of the application or have been authorized to act on behalf of the applicant.
Relationship to Patient:

Applications for assistance are reviewed twice a month. You will receive an update or request for additional information typically within 3 weeks of your application submission. 

Questions can be directed to meredith@gojengo.org.

keyboard_arrow_leftPrevious
Nextkeyboard_arrow_right
FormCraft - WordPress form builder

I’m writing to thank you guys again for all your support and assistance. DJ had the best x-mas ever and I was able to use the donations, gas cards to get around and take care of some important things. I’m feeling great and doing well emotionally/ physically and can’t wait until doctors release me to return to work. DJ will be turning 4 this Sunday and I still have some of the gifts from you guys saved to give him on his birthday. Today I met with the cancer oncologist and well the verdict is in… I do need chemo and will be starting cycles hopefully by the end of the month. I was also writing to ask for your assistance again with gas cards for my appointments, and if possible some help with funds. I asked my case manager of any resources or agencies that can help w/ car note or insurance but was unsuccessful in finding any. I’m behind my car payment due to not working and having no income since I went on medical leave Nov. I hope to return to work after port is put in for chemo and receiving first dose of chemo.

– Young Single Mother of a 4 year old

Leave Your Comment