If selected, the Glenn Garcelon Fund / ABTA Financial Assistance Grant is awarded to those who:

• Have a primary central nervous system (brain, spine, cranial nerves) tumor
• Reside in the United States (50 states and US territories)
• Have a yearly household income that is equal to or less than 500% of the US Federal Poverty Guidelines

To be considered for a grant, applicants are asked to complete and submit ALL of
the following items:

• Completed application form
• Medical Provider form (p.9-10) — Your medical provider must complete the form
• Proof of household income (in PDF format)
  • First two pages of signed copy of 1040 income tax return for the past 2 years (redacted social security numbers) for all non-dependent members of the household; or, if you do not file tax returns or have had a change in your employment, submit 3 months’ worth of copies of pay checks/stubs; unemployment checks; or social security, public assistance, and other benefit notifications for all non-dependent members of the household.
  • If the patient is a minor, financial records of parent(s)/guardian(s) must be submitted.

• Copies of bills (in PDF format)
  • Copies of up to three current bills that you are requesting be paid. Must include account number and mailing address of vendor.
  • If you are requesting help with rent, submit a copy of your rental lease that includes the patient’s name, amount of rent, account number, landlord’s or property manager’s name, and mailing address where payments are made.
• Medical information
  • Copy of patient’s pathology report (if biopsy/surgery performed)
  • Copy of most recent MRI report (NOT scan)
• Two high quality photos of the patient in jpg format.
  • If photos are sent separately from the application, please include the patient’s name.
  • Do not send a copy of a driver’s license or other ID card, and do not send
    pictures of patient’s head following surgery.

Please complete this application by filling out this form electronically (here) or by printing it out and handwriting your answers.

Additional documents (e.g., tax return info, path report, photos) can be uploaded with this application or emailed to FinancialAssist@abta.org or mailed to:

American Brain Tumor Association
Attn: Financial Assistance Program
8550 W. Bryn Mawr Ave, Ste 550
Chicago, IL 60631

Applications must be received in their entirety no later than the 15th to be considered for that month (except for December, when the deadline to receive everything is the 5th).

Please add FinancialAssist@abta.org to your contact list. We will send an email when your application is received and let you know if we need any additional items. By adding our email address to your contact list, you will ensure that our communication does not end up in your junk mail file and keep your application from moving forward in the review process.

Have other questions? Contact the ABTA at FinancialAssist@abta.org or call 800-886-2282.