Apply for Assistance


To apply for assistance you must currently be a resident of Rock County, WI and be in treatment for cancer. Current grant amount is up to $1,125 a year; this compensation amount is subject to funds available. These grants can be used for rent/mortgage, utility payments (water, electric, and sewer), phone/cable/internet bills, car insurance, health insurance, or car payments.

The application consists of 3 parts: an application form, authorization for disclosure of health information, and diagnosis verification form. Below are all of these forms; be sure to fully complete all of these forms before submitting application.

Rock County Cancer Coalition Application Form
Download Form
Authorization for Disclosure of Health Information
Download Form
Diagnosis Verification Form
Download Form
Request for Assistance
Download Form

When you have completed all of these forms please mail them to our PO box at:
Rock County Cancer Coalition
P.O. Box 2092
Janesville, WI 53547
 
If you have any questions or concerns you can contact us by email at info@rockcountycancercoalition.org or phone at 608-754-2286


Please Note:

Due to ongoing problems with Charter and Spectrum. RCCC will no longer be able to pay those bills for our clients.

Approved applications are identified by a unique client number to ensure confidentiality and only the executive director is aware of the name and private information of the applicant.