I confirm that I have been diagnosed with breast cancer and all answers I will give in this application regarding treatment and diagnosis will be related to my breast cancer diagnosis only.YesNo

Treatment StatusI am currently in active treatment (chemo, radiation, cancer removal surgery) or Stage IVI have finished active treatment in the last 6-12 monthsI have finished active treatment in the past 6 monthsI am no longer in active treatment but taking maintenance therapies for an extended period of time (ex: Tamoxifen for 5 years)I am currently NOT in Active Treatment

Based on your responses, you are not eligible to apply for a retreat. Little Pink Houses of Hope serves only breast cancer patients who are in active treatment at this time. We know anyone facing cancer deserves this type of vacation, but at this time you are outside of our eligibility guidelines.