Welcome!

The CCCP helps to pay for the cost of travel for cancer screenings. SPIPA Tribal members who are eligible can receive assistance with travel to screening and/or diagnostic appointments when they report a barrier or hardship related to travel.

The information being asked below will be used to determine your eligibility for travel assistance.

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1. By completing this form, I agree to be contacted by the SPIPA Cancer Programs staff who may ask for additional information in order to provide travel assistance. (Required.)

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2. Contact information (Required.)

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3. It is hard for me to afford or plan travel to my cancer screening / diagnostic appointments. (Required.)

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4. Please select the clinic where you receive care. (Required.)

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5. What type of cancer are you receiving screening or additional diagnostics for? (Required.)

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6. Please select the type of cancer screening you will be receiving (select all that apply). (Required.)

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7. Please provide the date of your appointment or the date you were referred if your appointment has not been scheduled yet. (Required.)

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8. I am requesting a $25 Visa gift card to assist with travel to and from a cancer screening appointment. I understand that I may qualify for up to 4 cancer screening travel assistance gift cards per program year.

Please note: a new Travel Assistance Request Form must be completed for each appointment. (Required.)

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