Ride2Survive Sullivan County, Inc.

Application

Transportation expenses will be supplemented to patients receiving cancer treatment at an accredited institution. Every applicant will be considered when an application is received. Every application will be reviewed. No one has been denied if they meet requirements.

HOW TO APPLY

To receive assistance with  travel-to-treatment expenses, please:

Patient Information

Please provide the requested information.

Oncologist Information

Expenses

If you checked any of the boxes above, please provide us with a little bit more detail. For example: How many weeks of radiation will you be receiving? How many chemotherapy treatments are you scheduled to have? What is the frequency of your visits? What transportation related expenses do you anticipate, such as - parking fees, tolls, etc.
By checking the box next to "I agree" below, you are stating that all of the information you have provided is correct and accurate to the best of your knowledge. You are also authorizing a Ride 2 Survive - Sullivan County, Inc. Board Member to reach out to your oncologist to verify the information you have provided. You also understand that the personal information you provided is not necessary but is important for releasing funds. You also acknowledge the the information provided to Ride 2 Survive - Sullivan County, Inc. will remain confidential and will not be shared with any third party. We respect your privacy and any conversations with be limited to you, your oncologist and a board member of Ride 2 Survive - Sullivan County, Inc.