The BCS service area is limited to selected areas in Southern California. If you live outside Southern California, we suggest contacting your local Susan G. Komen for the Cure Affiliate for possible resources.

BCS has a lifetime support limit of 9 months, as well as a per-person monetary limit. Once one of these limits has been reached, support is terminated and you may not renew at a later time. These limitations allow us to assist the growing number of women in our community who need our help.

Applications must be mailed or faxed in for processing. For privacy reasons, please do not send applications to any BCS email addresses.

Download a Word version of our application: BCS Application.doc


Download a PDF version of our application: BCS Application.pdf


Click the links above, and you will be directed to either open the file or save it to your computer (whatever you choose). If you have trouble, please email .(JavaScript must be enabled to view this email address). Thank you for your patience!.

To request an application to be sent to you, please call us at 1.866.960.9222 or email .(JavaScript must be enabled to view this email address)