Bridges of Hope Program

Watson Clinic Foundation has received a grant from the Florida Breast Cancer Foundation in the amount of $15,000 for the Bridges of Hope Program. This program aims to provide needs-based supportive services to economically impacted individuals undergoing treatment for breast cancer.

To be eligible for the program, applicants must currently:

Be undergoing active treatment in Polk County for a breast cancer diagnosis
Be a Polk County resident over the age of 18
Have an annual household income at or below 300% of the Federal Poverty Guidelines
Have less than $5,000 in total household liquid assets
Complete and submit the online application and submit all required support documentation
Be willing to fill out an online questionnaire upon completion of the program

Apply for Financial Aid

If you would like to apply for funding in 2026, please complete and submit the application below.

Items in bold indicate required information.

Full Name:

Date of Birth:

Address:

City:

State:

Zip:

Phone Number:

Email Address:

Date Applied:

Drivers License #:

Date Diagnosed:

Cancer Stage/Subtype:

Are you, or a family member, a current or past board member or officer of the Watson Clinic Foundation, or a committee member of the committee that will select recipients of grants, or an employee of Watson Clinic? If so, please state your family member's name and relationship and dates served:

Marital Status:

Number of People in Home:

Occupation:

Current Monthly Household Income:

Surgeon:

Current Treatment:

Oncologist:

Check stubs and/or SSA statement/tax return will need to be provided as proof of income:

Type of Relief I'm Seeking/Payment Request (Rent/Mortgage/Childcare/Utilities): A representative will be in contact for supporting documentation. If you are requesting a gas card, please complete the Transportation section.

Amount:

Past Due?:

Company:

Phone:

Address:

Account #:

Amount:

Past Due?:

Company:

Phone:

Address:

Account #:

Amount:

Past Due?:

Company:

Phone:

Address:

Account #:

Amount:

Past Due?:

Company:

Phone:

Address:

Account #:

Are any of the requested expenses covered by insurance? If so, how much of the expenses are not covered by insurance? (Example: some insurances have a monthly grocery allowance):

Have you received funds from any other sources to assist in paying the expenses? If so, please list here:

Agency:

Amount:

Date:

Transportation and/or Grocery Card Request - Applicants may request a one-time gas card or a grocery card to offset expenses incurred to travel to and from treatment. Please provide the treatment facility name and address:

Supporting Documentation: You will be asked to provide a copy of the first page of your statements that show balances of bank accounts, investment accounts, or other assets. You may redact (black out) account numbers, transactions, or any other personal information. We only ask that balance is shown as proof that you have less than $5,000 in liquid assets. This is one of the eligibility requirements for receiving assistance through this grant program.

Disclaimers and Signature: I certify that my answers are true and complete to the best of my knowledge. I am currently undergoing active treatment for Breast Cancer. I hereby grant Watson Clinic Foundation full authorization and permission to contact my medical providers to verify necessary medical treatment information to process my application for grant assistance. I understand that the Watson Clinic Foundation is not obligated to provide service to anyone, and assistance is not provided until eligibility is determined. I understand that this grant does not pay for medical expenses, but only expenses of the grant's limits (rent or mortgage, utilities, childcare, transportation, or groceries). It is my responsibility to obtain and provide all documentation to determine my eligibility to receive assistance under this specific grant program. I also understand that assistance will be paid to vendors directly, and not to me, except for one-time gas or grocery cards. Watson Clinic Foundation is not responsible if a vendor refuses to accept partial payments in the cases of rent or mortgage, or payment from the Foundation in general. The amount of each grant will be at the sole discretion of the Foundation at the time the grant is given. The Foundation will be under no obligation to distribute funds if no suitable applicants are found in any given period of time. The Foundation will not accept any contributions to the Bridges of Hope Program if the contribution is earmarked to benefit a specific individual or specified class of individuals. The Bridges of Hope program will not be used as a means of recruiting or retaining employees. Absent extraordinary circumstances, the Foundation will not make grants exceeding $750 per person. Further, absent extraordinary circumstances, no more than one award may be granted to any individual or family in a 6-month period. Applicants will be selected based on financial need and the severity and impact of hardship of the named applicant. Selections will be made without regard to race, color, national origin, age, sex, sexual orientation, or gender identity of the applicant.

Signature:

Date:

All applications must be submitted electronically online.

If you do not have access to a computer, please call 863-680-7559 or submit any questions via email to Jerri Huntt at JHuntt@WatsonClinic.com.

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