Eligibility requirements. You may be eligible for Foundation services such as Travel to Treatment mileage reimbursement, overnight lodging, grocery or emergency assistance if you meet the following criteria:

• Received a Cancer Diagnosis – Under the care of a Santa Fe oncologist, receiving treatment in Santa Fe such as chemotherapy and/or radiation
• Residency Requirement – You are a resident of New Mexico and at least 18 years of age
• Documented Income – At or below 300% of the 2024 Federal Poverty Guidelines as described below:

Documentation of Income

To qualify for assistance, you must provide proof that you meet the eligibility requirements outlined above. Please submit one of the following with your completed application:

• A copy of your most recent Federal Income Tax Return
• A copy of most recent State Income Tax Return if Federal was not filed
• If you have neither Federal nor State Tax Return documents, please provide an explanation and another form of income verification such as a social security award letter or pay stubs.

Instructions for Completing this Application

• Please fill out the secure online form below completely with signature and date at the bottom.
• Copies of tax returns or, if applicable, other documents showing income must be attached to this application
• If you qualify for assistance, it will begin on the day the application is completed and accepted.
  (No mileage assistance will be provided if an applicant is receiving that benefit from another source.)
• Submit your completed application and accompanying documentation via postal mail, email, or fax using the contact information provided below.

Questions?  Please contact Patient Service at (505) 955-7931 x. 403

Download, print and mail your application.