The application MUST be signed by the applicant and
their health care professional.
• Completed application
• A copy of Notice of Assessment for the last fiscal year (all 4 pages)
• A copy of spouse’s Notice of Assessment (if applicable) for the last fiscal year (all 4 pages)
• Only if on sick leave: Proof of employment income in the year prior to breast cancer diagnosis; last pay stub, recent proof of salary, disability insurance or employment insurance.
•A letter of intent*. It should:
1. Explain your desire to cold cap in detail.
2. Address the financial impact your diagnosis has had on you (and your family, if applicable)
IMPORTANT: Health care professional’s contact information should be clearly written and include a phone number and an email address. To avoid delays
in the application process, we strongly recommend that you select a readily contactable health care professional (preferably a social worker or nurse). NOTE: Your application will not be processed without a confirmation from a health care professional
A copy of your Notice of Assessment
from the last fiscal year. (all four pages)
If applicable, include the following documents:
- A copy of your spouse’s Notice of Assessment from the last fiscal year. (all four pages)
- Copies of birth certificates for all children under the age of 18.
- Only if on sick leave: Proof of employment income in the year prior to breast cancer diagnosis (e.g., last pay stub, recent proof of salary or disability insurance or employment insurance)
*CURE Foundation also welcomes letters of support written by your health care professional in addition to your letter of intent. Letters of support should be sent to us directly from your health care professional.
