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Apply for Assistance

One Time Gas Card Assistance

Please use the application provided below for the “One Time Gas Card” assistance. Applications must be complete with diagnosis, current treatment, physicians name/contact information and treatment facility. All applicants will be contacted within 5 days of receiving the application.

Extended Financial Assistance

Individuals applying for extended financial assistance or services other than a “One Time Gas Card” must fill out the full application complete with financial information and meet qualifying guidelines listed in the application. Please fax your completed application to (928) 235-6599.

Gas Card Application

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Please be aware that funds are limited and based on availability. Applicants must meet Shadows Foundation eligibility requirements.

Upon receipt of the acceptance letter, depending on patients needs the patient may be required to meet with a financial advisor provided by Shadows before final approval.