Shining Light B the Light Never Give up Hope

Nominate a Survivor

B the Light is a committed organization devoted to aiding breast cancer survivors through various means.

Throughout the challenges of a cancer journey, B the Light extends financial support to survivors residing in Minnesota. Eligible recipients among survivors can avail themselves of a one-time donation of up to $500 to alleviate financial burdens encountered during their breast cancer journey. Nominations must come from a treating physician or nurse, social worker, or nurse navigator.

Shining Light Nomination

Nominee's Full Name

B the Light extends financial support to survivors residing in Minnesota.

First Name

Last Name

Nominee's Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Nominee's Phone

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Nominee's Email

Your Full Name

First Name

Last Name

Your Email

Your Phone

(###)

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What is your relationship to the nominee? How long have you known them?

Can you provide details about the nominee's breast cancer diagnosis?

The more information provided will help our committee to determine eligibility. Diagnosis Date, stage, type of breast cancer?

Please provide current treatment status.

Information on the treatment plan. Is treatment ongoing, completed, or is there follow-up care?

Can you describe how the breast cancer diagnosis has affected the nominee's financial situation?

What is the nominee's current employment status?

Has their ability to work been affected by their diagnosis or treatment?

Why do you belive this person should receive a monetary donation?

I understand that financial assistance is not automatic and additional documentation may be requested by the board to determine eligibility. I understand that this is an application and it processed by a commitee and voted on.

Yes