Welfare Grants

A Welfare Grants Fund is administered by the Prostate Cancer Foundation to assist patients and families who are experiencing some hardship related to their treatment for prostate or testicular cancer. The grants are provided to assist with expenses relating to transport and accommodation, counselling and specialised services or equipment needed and are limited to $500. The grants are not available for medical, pharmaceutical or treatment costs (except physiotherapy through Pinc & Steel).

Welfare Grant applications can be made via the form below. For full Welfare Grant Terms & Conditions see the printable Application Form form. Copies of these are also available on request from the National Office – Phone 0800 477 678. Applications are reviewed by the Welfare Grants Committee every month.

Details of Applicant
Name*
First Last
Address*
Street Address Address Line 2 City Post Code Country
Email*
Phone*
Prostate Cancer Foundation Member*
Note: For stats purposes only. Does not affect grant consideration.
- Yes
- No
Support Group attended (if applicable)
Details of your disease*
Include dates of diagnosis and your treatment pathway
Details of the Grant requested
How much are you applying for?*
What are you applying for?*
Who is providing the service or equipment?
Please include name and contact details
Why do you need this service or equipment?
For Mileage Grants
Why is this needed?
Details of the Travel Required
Estimated kms
Where to / from?
For grants for Partners or Family/Whanau
Name(s) of others to benefit from this grant
How will this benefit them?
Supporting Documents*
Letter from doctor or urologist and/or quote/invoice from service/equipment provider. (PDF or WORD format)
Drop files here or
Endorsed by
If you are involved in a Support Group please name the Coordinator or Board Member who has endorsed your application.
First Last
Privacy Statement
- Please tick this box is you do not consent to receiving email communication from the Prostate Cancer Foundation in the future, which may include newsletters, cause-related and campaign information. The Foundation is committed to ensuring that your privacy is protected, will not share your information with any third parties and you can unsubscribe at any time.
Declaration: By clicking Submit you declare that the details on this application are true and correct, that you agree to the Terms & Conditions, and that any funds granted will be used for the purpose detailed in this application.