0800 66 0800 info@testicular.org.nz

Welfare Grants Fund

We understand that a diagnosis of prostate or testicular cancer can place a considerable financial burden on not just the person diagnosed but also their families, including loss of income and additional costs associated with the consequences of treatment. To assist patients and their families who are experiencing hardship related to their treatment for prostate or testicular cancer, we provide assistance through our Welfare Grants Fund. 

Applications can be made online via the link below. Alternatively download and use the printable Application Form (see link below). Please also see this same form for the full Terms & Conditions, and the Privacy Policy linked in the footer. Copies of this document are also available on request from the National Office – phone 0800 477 678. Welfare Grants Fund Application Form (PDF)

The Welfare Grants Fund is supported by the Dry July NZ Trust.

Welfare Grant Application Form

Please complete all the details below, in full. If you are completing this form on behalf of someone that has been diagnosed with prostate or testicular cancer please complete the Applicant Details fields. If you are the Applicant, please forward to the Grant Beneficiary Details Section.

I am applying on behalf of someone else

Please only complete this if you are applying on behalf of someone else. If you are applying for yourself, please skip to the next section 'I am applying for myself'
Name
Your Address

I am applying for myself

Please complete the following details if you are applying for yourself
Name
Address
Does this application relate to Prostate Cancer or Testicular Cancer
Are you a PCFNZ Member?
Have you applied for Ministry of Health National Travel Assistance?

For grants for Partners or Family / Whanau

Supporting Documents and Declaration

Checklist
Max. file size: 256 MB.