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.

Welfare Grant applications can be made via the form below. Print forms are available here or 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
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 a Board Member who has endorsed your application.
First Last
By clicking Submit you declare that the details on this application are true and correct and that any funds made will be used for the purpose detailed in this application.