Step 1 · Assistance Application
CCA Application 2025
Apply for help by sharing personal, financial, medical, and referral details used to determine eligibility and coordinate assistance.
Get Help
Apply for Assistance
Three short forms, one sitting. No account, no password, and nothing to pay. If filling in a form online is not for you, call (254) 202-8082 and we will do it together.
You don't have to use this form
Call or email and we will take your application over the phone, post it to you, or sit down with you at the office. It makes no difference to the help you get.
Before You Start
What you'll need
Nothing has to be exact. If you do not have something to hand, leave it and we will fill in the gaps when we speak.
- Your address, phone number, and date of birth
- The type of cancer you are being treated for, and roughly when you were diagnosed
- The name and phone number of the doctor treating your cancer
- What medical insurance you have, if any
- A rough idea of your household income and how many people live with you
- The name of anyone who referred you to CCA
What Happens Next
Three steps, then a phone call
- 1 Send us your application Complete the three forms below in one sitting. There is no account to create, no password, and no login — you fill them in and send them.
- 2 Terry reads it The Executive Director reviews every application personally and will normally get in touch within one to two business days.
- 3 We work out what CCA can cover We talk through your situation, what we can help with, and what we need from you. If we can help, we pay approved vendors — the pharmacy or supplier — directly.
How your information is handled
What you send goes to the Community Cancer Association office in Waco and is read by the Executive Director, Terry Hunt. CCA is a one-person staff — nobody else reviews applications.
Your medical and financial details are used only to work out how CCA can help and, with the HIPAA authorization you sign below, to speak with your pharmacy, physician's office, clinic, hospital, or an approved social service agency about the items we are paying for. Nothing is sold, published, or shared for any other purpose. You can withdraw that authorization in writing at any time.
The Application
Complete Your CCA Forms Online
Open each form, fill it in, and send it — all without leaving this page. Please complete all three.
Step 2 · Medical Records Release
CCA HIPAA Authorization 2025
Authorize medical providers, pharmacies, clinics, hospitals, and social service agencies to release information needed for financial or medical assistance.
Step 3 · Terms Agreement
CCA Terms of Service 2025
Review and acknowledge the terms for receiving assistance, including eligibility, approved vendors, medication, supply, and travel guidelines.
Not sure whether CCA can help?
Ask before you apply. There is no wrong way to start the conversation, and it costs nothing to find out.