Fondation « Randonnée des Neiges de Kelly Shires contre le Cancer du Sein »

Télécharger le formulaire à remplir en appuyant ici.

 

 Fondation « Randonnée des Neiges de Kelly Shires contre le Cancer du Sein »

Télécharger le formulaire à remplir en appuyant ici.

 

Download application form.

How to make a request for financial assitance?

 

Policy: Criteria governing how the charity will administer funds to breast cancer patients in need across Quebec. These funds do not come from the government and we depend solely on the generosity of our donors. Our Foundation is operated only by volunteers; there are no employees.

 

Purpose: This policy is to guide the association and the approval committee in dealing with requests from applicants who submit a formal application to the charity requesting financial assistance. Our mission is to provide assistance to women/men in order to make their fight with breast cancer a little less challenging.

 

IMPORTANT: We do not receive any kind of government funding and rely solely on donations received from Quebec residents.   Our charity operates only with volunteers!

 

Policy Statements:

 

1. One must complete the application in full, including supporting documents outlining their need for financial assistance and mail it to our Montreal address. No fax application will be considered. A request in which there will be missing documents will be considered incomplete and delay it’s process.

2. The applicant must be diagnosed with breast cancer.

3. The applicant must be a Canadian citizen or an approved landed immigrant. The request can only be processed if you are a resident of Quebec. If you are resident of another province, please contact our office in Ontario or visit their website: www.kellyshiresfondation.org

4. Each application can be submitted once per month for a maximum amount of $1,000.00 and no more than 4 times per fiscal year. However this applies only if funds are still available.

5. In order to establish financial need applicants must provide the following documents:

 

   √ Medical proof of breast cancer and or treatment in progress

   √ It is MANDATORY to supply your current notice of assessment of taxes and that of your                spouse if this applies ( the approval committee reserves the right to request previous years of complete income tax returns). T4, T4A or other partial proof is not acceptable.

   √ Original receipts must be provided for amounts claimed through the fund in regards to medication, groceries, transportation, prosthetics, etc… (no photocopies).  

   √ If the request asks for financial aid with mortgage/rent, please provide us with your mortgage statement or rental agreement.

   √ A copy of your birth certificate/baptismal record/landed immigrant status MUST BE provided with your first request.

   √ Copy of estimates when you request advance of funds.

 

6. On occasion, testimonials can be requested by approval committee indicating how the charity has helped the applicant

 

7. All applications will be reviewed by at least 4 of the 6 approval committee members. If requests for funding do not meet the criteria listed, especially in cases where alternative medicines are being sought, these requests will also be reviewed by a licensed medical practitioner.

 

8. Policies and criteria are reviewed annually and amended accordingly.

 

9. All personal information is protected under the Canadian Privacy Act. The application remains confidential and may not be shared.

 

10. The committee reserves the right to deny an application if they deem the request to be outside the criteria. There is no obligation to approve a request.

(Please note that applications cannot be considered complete and put before the committee unless ALL pertinent documentation is included, documentation requested is mandatory – if documentation is not included it will only delay any financial assistance that could be provided).

Some examples that fit the funding criteria (but not limited to):

 

                Transportation to/from the centre for appointments or treatment

             Accommodation

             Medication that is not covered by any other plans (or non- covered % portions)

             and related to breast cancer

             Parking at the cancer centre/hospital

             Food costs only while on active treatment

             Child-care services while at the centre/hospital for an appointment or treatment or in

             hospital

             Home health aides while undergoing treatment

             Wigs and/or hats

             Prosthetics/specialized lingerie

             Rent payment/Mortgage payment

             Supportive care: counseling services for patient, partner and/or children; attendance

             to a cancer support program/course

             Rehabilitation supportive care: e.g., lymph edema management, weight

             management/nutrition consultation special needs due to chemo treatment: e.g.

             prescription glasses due to change of vision. Will need approval from a licensed

             medical practitioner.

             Other expenses related to treatment, living costs during treatment & recovery

             Expenses not listed above can be submitted and considered after review by Directors

             and approval committee

 

IMPORTANT: certain items have a “cap” on the amount refunded per request

 

Application Process:

 

1. Submit a completed application by mail only to the Foundation (all 5 pages must be filled in and signed each time). This can be downloaded on-line at www.randoneedesneiges.org or requested by mail or by calling: 1-866-717-7773. The applicant shall supply medical proof of present health condition. The applicant must disclose if they are receiving any financial assistance from other sources (e.g., programs in centre, health insurance programs, group insurance programs.

 

2. Priority will be given:

a - to low income applicants (the number of household dependant will be taken into consideration as per government criteria)                                                                                                     b – Only Quebec residents can apply for assistance to this fund with exception of residents from other provinces who need to apply directly to the head office in Midland, Ontario (www.kellyshiresfoundation.org)                                                                                          

c - To applications where costs are medically related to breast cancer diagnosis and treatment

3. Applicants will be notified of application status within 5 business days of submitting a completed application form & supporting documents. If documents are missing, this does not apply

4. Funds will be mailed out to the applicant.

5. Please note that we wish to help as many applications as possible throughout the year and to do so we have modified certain items with maximum allowance per request:                                                                            - mortgage/rent will be capped at $700 per request

 – groceries will be capped at $500 per request     

 – utilities (hydro/heating/water/telephone) will be capped at $400 request  

– financial aid will be capped in a lifetime to $10,000 

6. Certain items NOT COVERED by our Foundation:

- credit card payments or all other pending credit (exception to mortgage)                               

 – school taxes                                                                                                                   

– property taxes or all other taxes                                                                                

- car repairs                                                                                                                    

– Internet/Cable/Television expenses                                                                   

- Cell phones (exception made if only phone available)                                   

– Home/Car/Life insurances                                                                                      

- Medication et fees not in your name           

 

OTHER APPLICATIONS OF THE FUND:

Annually the charity can choose to donate funds to cancer centers, hospitals or research within

 

Quebec, funds permitting.

Toll free: 1-866-717-7773                    

Montreal: 514-396-7773                            

Quebec: 418-686-5578

Fondation Kelly Shires                               

5875 rue Boyer – Apt 1

Montreal, QC. H2S 2H8

 

Downoad application form.  

Download application form.

How to make a request for financial assitance?

 

Policy: Criteria governing how the charity will administer funds to breast cancer patients in need across Quebec. These funds do not come from the government and we depend solely on the generosity of our donors. Our Foundation is operated only by volunteers; there are no employees.

 

Purpose: This policy is to guide the association and the approval committee in dealing with requests from applicants who submit a formal application to the charity requesting financial assistance. Our mission is to provide assistance to women/men in order to make their fight with breast cancer a little less challenging.

 

IMPORTANT: We do not receive any kind of government funding and rely solely on donations received from Quebec residents.   Our charity operates only with volunteers!

 

Policy Statements:

 

1. One must complete the application in full, including supporting documents outlining their need for financial assistance and mail it to our Montreal address. No fax application will be considered. A request in which there will be missing documents will be considered incomplete and delay it’s process.

2. The applicant must be diagnosed with breast cancer.

3. The applicant must be a Canadian citizen or an approved landed immigrant. The request can only be processed if you are a resident of Quebec. If you are resident of another province, please contact our office in Ontario or visit their website: www.kellyshiresfondation.org

4. Each application can be submitted once per month for a maximum amount of $1,000.00 and no more than 4 times per fiscal year. However this applies only if funds are still available.

5. In order to establish financial need applicants must provide the following documents:

 

   √ Medical proof of breast cancer and or treatment in progress

   √ It is MANDATORY to supply your current notice of assessment of taxes and that of your                spouse if this applies ( the approval committee reserves the right to request previous years of complete income tax returns). T4, T4A or other partial proof is not acceptable.

   √ Original receipts must be provided for amounts claimed through the fund in regards to medication, groceries, transportation, prosthetics, etc… (no photocopies).  

   √ If the request asks for financial aid with mortgage/rent, please provide us with your mortgage statement or rental agreement.

   √ A copy of your birth certificate/baptismal record/landed immigrant status MUST BE provided with your first request.

   √ Copy of estimates when you request advance of funds.

 

6. On occasion, testimonials can be requested by approval committee indicating how the charity has helped the applicant

 

7. All applications will be reviewed by at least 4 of the 6 approval committee members. If requests for funding do not meet the criteria listed, especially in cases where alternative medicines are being sought, these requests will also be reviewed by a licensed medical practitioner.

 

8. Policies and criteria are reviewed annually and amended accordingly.

 

9. All personal information is protected under the Canadian Privacy Act. The application remains confidential and may not be shared.

 

10. The committee reserves the right to deny an application if they deem the request to be outside the criteria. There is no obligation to approve a request.

(Please note that applications cannot be considered complete and put before the committee unless ALL pertinent documentation is included, documentation requested is mandatory – if documentation is not included it will only delay any financial assistance that could be provided).

Some examples that fit the funding criteria (but not limited to):

 

                Transportation to/from the centre for appointments or treatment

             Accommodation

             Medication that is not covered by any other plans (or non- covered % portions)

             and related to breast cancer

             Parking at the cancer centre/hospital

             Food costs only while on active treatment

             Child-care services while at the centre/hospital for an appointment or treatment or in

             hospital

             Home health aides while undergoing treatment

             Wigs and/or hats

             Prosthetics/specialized lingerie

             Rent payment/Mortgage payment

             Supportive care: counseling services for patient, partner and/or children; attendance

             to a cancer support program/course

             Rehabilitation supportive care: e.g., lymph edema management, weight

             management/nutrition consultation special needs due to chemo treatment: e.g.

             prescription glasses due to change of vision. Will need approval from a licensed

             medical practitioner.

             Other expenses related to treatment, living costs during treatment & recovery

             Expenses not listed above can be submitted and considered after review by Directors

             and approval committee

 

IMPORTANT: certain items have a “cap” on the amount refunded per request

 

Application Process:

 

1. Submit a completed application by mail only to the Foundation (all 5 pages must be filled in and signed each time). This can be downloaded on-line at www.randoneedesneiges.org or requested by mail or by calling: 1-866-717-7773. The applicant shall supply medical proof of present health condition. The applicant must disclose if they are receiving any financial assistance from other sources (e.g., programs in centre, health insurance programs, group insurance programs.

 

2. Priority will be given:

a - to low income applicants (the number of household dependant will be taken into consideration as per government criteria)                                                                                                     b – Only Quebec residents can apply for assistance to this fund with exception of residents from other provinces who need to apply directly to the head office in Midland, Ontario (www.kellyshiresfoundation.org)                                                                                          

c - To applications where costs are medically related to breast cancer diagnosis and treatment

3. Applicants will be notified of application status within 5 business days of submitting a completed application form & supporting documents. If documents are missing, this does not apply

4. Funds will be mailed out to the applicant.

5. Please note that we wish to help as many applications as possible throughout the year and to do so we have modified certain items with maximum allowance per request:                                                                            - mortgage/rent will be capped at $700 per request

 – groceries will be capped at $500 per request     

 – utilities (hydro/heating/water/telephone) will be capped at $400 request  

– financial aid will be capped in a lifetime to $10,000 

6. Certain items NOT COVERED by our Foundation:

- credit card payments or all other pending credit (exception to mortgage)                               

 – school taxes                                                                                                                   

– property taxes or all other taxes                                                                                

- car repairs                                                                                                                    

– Internet/Cable/Television expenses                                                                   

- Cell phones (exception made if only phone available)                                   

– Home/Car/Life insurances                                                                                      

- Medication et fees not in your name           

 

OTHER APPLICATIONS OF THE FUND:

Annually the charity can choose to donate funds to cancer centers, hospitals or research within

 

Quebec, funds permitting.

Toll free: 1-866-717-7773                    

Montreal: 514-396-7773                            

Quebec: 418-686-5578

Fondation Kelly Shires                               

5875 rue Boyer – Apt 1

Montreal, QC. H2S 2H8

 

Downoad application form.