FINANCIAL AID APPLICATION

The purpose of Miles for Moms is to provide charitable contributions to people fighting breast cancer who cannot afford it, encourage early detection of breast cancer, and increase breast cancer awareness one mile at a time. Our annual trail run event will be held on October 5, 2024 at Great Brook Farm in Carlisle, MA.

Please submit this application form if you (or a loved one) has been financially impacted by breast cancer this year. The Board will choose a few applicants each year to support with our annual Miles for Moms event. Through this application, we hope to learn more about you (or your loved one) and help you (or their) fight the financial burden breast cancer may have caused. We look forward to reading your stories!

Submission deadline is August 16, 2024

Name

First Name

Last Name

Phone

(###)

###

####

Are you applying for yourself or on behalf of someone else?

If you are applying for someone else, please provide their name and contact info.

Check all that apply to the applicant.

Mom

Expecting mom

Planning to be a mom

Grandmother

Aunt

Walker or runner

Biker, swimmer, or hiker

Other

Please share your breast cancer story.

How much financial aid is the applicant looking to receive from Miles for Moms?

Note: If you are approved by Miles for Moms for financial aid, the 'approved' amount will depend on how much we can fundraise through our annual event and receipts for reimbursement will be required.

If your application is approved for financial aid, is the applicant okay with sharing your story publicly on our website?

Is there anything else we should know about you?

FINANCIAL AID APPLICATION

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