Get ready to apply
UVSC
Financial Assistance Program
What you get
Up to $10,000 per 12 months during treatment, or $5,000 per 12 months for up to two years afterward, for approved medical expenses and basic needs. Ask whether requests are open.
- Who starts it
- You, with a document from your social worker or doctor
- How it’s sent
- Email to team@uvsc.org
- Your time
- An hour or so, plus waiting for the document
- Last checked
- Aug 27, 2026
Before you start, check you fit
- Your child is 25 or under at diagnosis.
- The 12-month period starts with your first reimbursement request.
- Requests are subject to board-approved budget restrictions and available funds.
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Ask your social worker or doctor for the documentStart here. This is the part that takes the longest.
UVSC needs a signed confirmation of the diagnosis from your social worker or doctor. It has to cover one thing. Copy this message, or say it in person at the next visit.
Hi [social worker’s name], We’d like to apply to UVSC’s Financial Assistance Program. They offer up to $10,000 per 12 months during treatment, or $5,000 per 12 months for up to two years afterward, for approved medical expenses and basic needs, and we are checking whether they are taking requests. They need a signed confirmation of the diagnosis from you or someone on the care team. It has to cover professional knowledge relevant to the applicant's situation and financial need. Their form and instructions are here: https://uvsc.org/services/ Could you do that when you have a chance? I can send you the link, or bring a printout to our next visit. Thank you for everything you do for us. [your name] · [phone]
Copying is the only thing this page does with your text. Nothing is saved. -
Fill in their applicationIt is on their website.
Open their application ↗ Checked Aug 27, 2026What the form asks for
2026 family application preparationIs the individual in cancer treatment a Hawai'i resident? ** Only Hawai'i residents are eligible to receive UVSC servicesFirst and Last Name of Individual in Cancer TreatmentDate of Birth of Individual in Cancer TreatmentAgeRace and Ethnicity of Individual in Cancer Treatment (check all that apply)Gender of Individual in Cancer TreatmentHealth Insurance Provider (Primary)Health Insurance Provider (Secondary) - If applicableIf Individual with Cancer is a Minor: Parent/Guardian First and Last NameRelationship to Child in Cancer Treatment (*please put N/A if not applicable)Do you have a caregiver (i.e. some who helps to care for you)Caregiver Relationship to Individual in Cancer TreatmentHow did you hear about usPrimary AddressCityState (*Must be a Hawaii Resident to be eligible for services)ZIP codeTemporary Address (if away in treatment)Phone numberSecondary Contact Phone Number (if applicable)Email addressPreferred Method of Contact (check all that apply)Case Manager/Social Worker Name (First and Last)OrganizationContact Email or Phone NumberNumber of Individuals in Household (supported by Household Income reported)Member 1Member 2Member 3Member 4Member 5Member 6Member 7Member 8Annual Gross Household Income (includes all wages, salaries, tips, investment income, public benefits, etc.)Has your household income recently changed or is it expected to change due to your cancer diagnosis or treatmentAre you currently employedIf you are employed and on leave, when did your leave start? (approximate date)Please tell us more about your cancer diagnosis and treatmentCurrent situation and financial needsDo you need to travel off-island for your cancer treatmentHow urgent is your financial needHave you been directly impacted by a natural disaster in Hawaiʻi (fire/flood)If yes, and you’d like to add context, please describe belowHave you applied for or received assistance from other organizationsWhat type(s) of government assistance are you currently receiving? Please select all that apply. If you are not currently receiving government assistance, please check “None”What other types of financial assistance have you applied for to assist with your cancer-related expensesWhat, if any, financial assistance has been receivedType of Expense (check all that apply)How much financial assistance do you need in the next 12 months (estimated) to cover the expenses noted aboveWhich of these statements best describes the food eaten in your household in the last 12 monthsHow often have you been worried whether your food would run out before you got money to buy more"(I/we) couldn’t afford to eat balanced meals.” How frequently was this true for (you/your household) in the last 12 monthsAre you interested in receiving food or meal assistance for you and your familyFirst and Last Name of Individual Completing Statement of Attestation aboveBy Typing your First and Last Name Below, you are in agreement with the statements aboveProvider verification preparation · your care team fills this inYOUR FIRST AND LAST NAME (Must be a referring Case Manager or Social Worker; or Medical Provider)Organization NameJob TitleContact Phone NumberContact EmailFirst and Last Name of treating oncologist or medical providerPhone NumberEmail AddressFirst and Last Name of Individual in Cancer TreatmentPatient Date of BirthDiagnosis (Cancer Type)Date of DiagnosisCurrent StageTreatment FacilityAny additional information that you feel would help UVSC understand the applicant’s situation and need for financial assistanceTo the best of your knowledge, do you attest that the annual household income reported in the applicant's UVSC Financial Assistance Application is accurateHow many individuals are supported by the household income reported by the applicantAny additional information that you feel would help UVSC understand the applicant’s situation and need for financial assistanceHave ready
- Two supporting financial documents only when the provider does not complete financial-need verification; examples include bank statements, pay stubs, tax filings, aid letters, public-benefit documents, or other hardship evidence.
- Authorization allowing UVSC to verify diagnosis, treatment status, care coordination, financial references, and relevant expenses.
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Email your application and the document togetherTo team@uvsc.org. Your social worker or doctor can send it instead if the document has to stay with them.
- Submit the family application online; the professional submits the separate provider form; the family signs the release and sends conditionally required income proof to UVSC by email or mail.
Email: team@uvsc.org
Subject: Financial Assistance Program application, [child’s name] Hello, Attached are our completed application and the document from [social worker’s name] at [hospital]. Please let me know that it arrived and if anything is missing. Thank you, [your name] · [phone]
After you send
The live 2026 form says UVSC confirms online applications within 7–10 business days and the Board reviews eligible applications quarterly. If confirmation does not arrive, email team@uvsc.org and identify which components were submitted without sending sensitive identifiers in ordinary email. If you have not heard back by then, write and ask.