Application for Assistance

A Woman Like You Foundation

Application for Assistance

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A Woman Like You Foundation of Kentuckiana, LLC is a nonprofit organization dedicated to assisting Louisville, Kentucky area residents who are battling cancer and lack sufficient health insurance or financial resources.

To apply for assistance, download, print, and complete the application form by clicking the pink box below. The application includes an Authorization to Release Hospital Records and/or Divulge Medical Information. Be sure to complete that section as well.

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If you have questions, contact us at (502) 802-3500 or (502) 608-7761

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IMPORTANT!

You must sign the releases at the bottom of each page before sending us this application.

All information is strictly confidential.

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*A Woman Like You Foundation of Kentuckiana is a non-profit organization, which provides non-medical supplemental financial

assistance to single women who are cancer patients in the Louisville, KY area.