THE LEUKEMIA AND LYMPHOMA SOCIETY.PDF

Created: 02/02/2018 • Last updated: 03/06/2018
General information
Organization The Leukemia and Lymphoma Society
Contact First name Naomi
Contact Last name Martinez
Contact e-mail naomi.martinez@lls.org
Contact phone number 6025677612
Address
Street 3877 N 7th St Ste 300, www.lls.org/az
City Phoenix
State AZ
ZIP Code 85014
From what tribe is the Gila River Indian Community
organization requesting the
grant?
Total grant amount request 75,000
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The Gila River Indian Community offers multi-year awards. If your organization is
requesting a multi-year grant for this project or program from the Gila River Indian
Community, enter the amount to be requested each year.
Amount
Year 1 (Gila River Indian
75000
Community Grants Only)
Year 2 (Gila River Indian
Community Grants Only)
Year 3 (Gila River Indian
Community Grants Only)
Year 4 (Gila River Indian
Community Grants Only)
Year 5 (Gila River Indian
Community Grants Only)
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Gila River Indian Community Grant Application
Grant Cycle 2018
Cover Sheet
Municipality Information
1. Date of Application: 2/6/2018 (NOTE: Click or use up/down arrow keys to move among fields)
2. Name of City, Town or County: Phoenix, AZ Maricopa County
3. Mayor (City or Town) or Board of Supervisor’s Chairman (County): Steve Chucri, Maricopa County Board of
Supervisors
4. Mailing Address: 301 W. Jefferson St., #10
5. City: Phoenix State: Arizona Zip Code: 85003
6. Acknowledgement of Submission by Authorized Municipality Representative:
Typed Name/Title: Zachary Wolfe, Finance Department Signature:
Applicant Information
7. Department/Organization Name: The Leukemia & Lymphoma Society
8. Is this a 501c non-profit Organization? No Yes If yes, attach IRS Determination Letter
9. Application Contact Person: Naomi Martinez Title: Development Specialist
10. Phone Number: 602.567.7612
11. Mailing Address: 3877 N. 7th St #300
12. City: Phoenix State: Arizona Zip Code: 85014
13. Email Address: naomi.martinez@lls.org Website Address: lls.org
Project Information
14. Project Name: Leukemia & Lymphoma Society Local Travel Assistance Program
15. Purpose of Grant: To assist patients and their families with a one time stipend with travel fees associated with
treatments, appointments, and therapies
16. Priority Funding Area Healthcare
17. Annual amount requested $75,000
18. Number of years that funding is requested 1 year
19. Total amount requested (annual amount x $Click here to enter text.
number of years)
20. Has your organization received past 2015 $25,000
funding from GRIC? If yes, list each year and 2017 $25,000
amount
21. Geographic area served The state of Arizona
For Office Use Only:
Data Entry Receipt Evaluation
Outcome  Approval Recommended/Amount $  Denial

Gila River Indian Community Grant Application
Grant Cycle 2018
Narrative
Please structure your proposal to provide the following information in the order indicated. Provide the narrative in
paragraph form in the text field provided. Please be thorough but strive for brevity.
1. Briefly describe the organization’s history, mission and goals.
The Leukemia & Lymphoma Society, a 501(c) (3) organization, is the largest not-for-profit health
agency dedicated to finding cures and better treatments for people with leukemia, lymphoma or
myeloma—collectively known as blood cancers. More than 1 million Americans are currently
living with, or in remission from, a blood cancer. Every 3 minutes, someone new is diagnosed
with a blood cancer, with more than 155,000 new cases expected this year. Blood cancers are
the number three cancer killer, behind cancers of the respiratory and digestive systems,
including lung and colon. Every 10 minutes, a child or adult dies from a blood cancer - that’s
more than 55,000 deaths this year. LLS has one goal: a world without blood cancers. Thanks in
part to innovative research funded by LLS, survival rates for many blood cancers have doubled,
tripled and even quadrupled since the 1960s. We are making tremendous progress. However,
more than a third of patients do not survive five years after their blood cancer diagnosis, and
leukemia still causes more deaths than any other cancer among children and young adults
under the age of 20.
Since its founding in 1949, LLS has invested more than $1 billion in research to advance
therapies and save lives. Advised by leading biomedical research and clinical experts, LLS
identifies and funds the most promising blood cancer research projects around the world. Unlike
corporations that invest in drugs offering the best profit potential, LLS funds research based on
unmet medical needs of blood cancer patients, without restriction by commercial return, market
size or geography. LLS’s investment in research has played a critical role in advancing many of
today’s life-saving therapies, including targeted therapies. LLS recognizes that finding cures is
not enough; we need to ensure that patients have access to the treatments they need to live
longer, better, healthier lives. LLS is dedicated to removing barriers to care. LLS is the voice for
blood cancer patients, working with regulatory bodies (i.e., FDA) and state and federal
legislatures to drive policies that accelerate the development and approval of innovative
treatments and ensure that patients have access to quality, affordable, coordinated care. LLS is
the leading source of free blood cancer information, education and support for patients, families
and healthcare professionals. Services include national and community-based programs
including travel assistance, co-pay assistance, clinical-trial search and peer-to-peer support.

Gila River Indian Community Grant Application
Grant Cycle 2018
The Arizona Chapter of the Leukemia & Lymphoma Society (LLS) provides services to blood
cancer patients living in the 15 counties of Arizona. In the last fiscal year, LLS distributed nearly
$2 million direct financial assistance to Arizona families battling blood cancers. This includes
direct financial aid through our local travel assistance fund and co-pay assistance program,
which helps patients meet theirco-payment obligations related to treatment.
2. If the applying organization is non-municipal or a non-profit 501c, please describe your relationship with Arizona
municipalities including past and present support, whether through partnerships, collaborations, in-kind
contributions, grants, tax-based funding or other. Describe the supporting municipality’s role in this project. If
the applying organization is a municipality governmental sub-division please enter the text “Not applicable.”
Municipality’s role in this project is to act as intermediary between the tribe and 501c3
3. Describe the proposed project and planned goals and activities.
LLS's Patient Travel Assistance Program, provides financial assistance to people diagnosed with a blood
cancer who struggle to pay for treatment-related transportation and/or lodging costs (e.g., parking, tolls,
gasoline, plane or train tickets, temporary housing). Qualified patients receive an annual stipend of $500 to
help cover these expenses. Applicants to the program must meet the following eligibility criteria:
 Applicants (patients) must be US citizens or permanent residents; and
 Applicants must have a confirmed blood cancer diagnosis; and
 Applicants must meet financial eligibility criteria defined as an annual household income at or below 500% of
the Federal Poverty Level.
This grant will be 100% restricted to LLS’s Patient Travel Assistance Program and will aid
blood cancer patients with financial need in the state of Arizona by helping to cover treatment-related travel
and lodging expenses. LLS has recognized this as an area of unmet patient need and a significant barrier to
access for many patients. The Gila River Communities’ support will help LLS break down this financial barrier
and allow more patients to access the care they need. Annually we partner with local Arizona health care
providers who provide referrals who are elgible for the above criteria.
4. Describe how the proposed project satisfies one or more of the priority funding areas identified by the Gila River
Indian Community.
The proposed project would cover the area of healthcare priority funding for Gila River Communities. Within
the healthcare umbrella, this project would address direct patient care and programs assisting in improving
overall health of participants and community of Arizona. There will be an estimated 33,000 new cases of blood
cancer in Arizona thisyear. LLS anticipates an increase in need as the incidence of blood cancer continues to
rise. Blood cancers occur in individuals of all ages and gender. There are very few known causes of blood
cancers and no opportunities for prevention or early detection.

Gila River Indian Community Grant Application
Grant Cycle 2018
5. Identify the needs/problems to be addressed, target population and number of people to be served by the
project.
The Travel Assistance Program (TAP) will serve blood cancer patients residing within the 15 counties in the
state of Arizona. We have initiated the program because patient feedback consistently identified financial
assistance as an area of unmet need. Often a lack of financial resources represents a significant barrier to
access to necessary care.
Patients often express fear and concern over the immense financial burden that comes with a cancer
diagnosis. While LLS does offer co-pay assistance to help with insurance co-pay obligations and premiums,
the expenses of traveling to and from treatments can be quite substantial and these expenses are not covered
under the co-pay program. LLS will target this assistance to those who need it most by requiring an attestation
of financial need.
LLS regularly receives calls from patients in crisis who cannot move forward with potentially life-saving
treatments because they cannot afford to pay for transportation to get to their providers, e.g., doctors,
hospitals, transplant centers, and research or clinical trial centers. As patients increasingly need to travel to
see a specialist for treatment, follow-up, or special tests to make the most of their chance to fight for life, these
costs and burdens are only increasing. Some patients have no transplant center in their state or surrounding
area and they are faced with the challenges of flying to a treatment center and residing far from home for an
extended period of time. Other patients who are immuno-compromised cannot take public transportation. Taxi
fares or the cost of gas, tolls and parking fees to get to numerous appointments over weeks, months or years
is a great burden. Regardless of geography, the out-of-pocket costs associated with traveling for care are
prohibitive for many patients and reduces the funds available for basic needs such as food, shelter and utilities.
This is especially true of patients in Arizona’s rural communities.
Oncologists and practice managers rely heavily on advocacy organizations like LLS to provide reimbursement
for treatment-related expenses like transportation to assist patients’ access to care (2012 Kantar Health
Oncologist and Practice Manager Surveys). LLS is viewed by healthcare professionals as a crucial resource
that provides education and support to patients. Addressing the logistics of getting to and from doctors’
appointments and securing temporary housing when appropriate for certain treatment protocols is a crucial
piece of the treatment planning process.
If transportation/lodging needs are not met, issues with compliance and adherence to treatment regimens
arise, which can affect survival outcomes for blood cancer patients. Further, travel obstacles can have a direct
impact on clinical trial enrollment. LLS has received numerous reports from our LLS-funded investigators
stating that transportation challenges prevented appropriate candidates from enrolling in clinical trials.
All of these factors affirm the value and necessity of LLS’s Patient Travel Assistance Program to
help patients better manage a life-threatening blood cancer diagnosis. Our experience with the Travel
Assistance Program confirms this—

Gila River Indian Community Grant Application
Grant Cycle 2018
LLS has already distributed nearly over $150,000 in Local Travel Assistance to patients locally since FY 2015
and receives an average of 50 inquires about Local Travel Assistance per day. The need is clearly there AZ-
LLS strives to meet it
6. Define the project as a new or continuing program.
The Local Travel Assistance Program launched nationally in spring of 2014. The Arizona
Chapter has begun the process of securing funding locally because money raised in Arizona will
stay within the community and help local residents. While the need within the patient
community will be continuing, the program is new for some patients in Arizona as they have not
had the opportunity to apply locally for patient funding for transportation for medical needs
through this program.
7. Provide a brief timeline including start and finish dates. Indicate if the timeline is flexible.
April 2018: Develop fundraising and program plan for upcoming fiscal year. Start to submit letters of inquiry to
healthcare partners in AZ
*October/November 2018: Begin the program- evaluate applications from patient waiting lists as grant funds
become available.
November 2018: Executive Director, Donor Development Specialist, and Community Director to continue to
work with healthcare providers, and social workers to evaluate the need for transportation and evaluate
progress.
January 2019-May 2019 Continual application process and re-evaluate monthly. Final evaluation of entire
program and assess its overall effectiveness within the community
*Dates dependent on grant funding disbursement
LLS will keep records of the number of patients served by the Travel Assistance Program, including age and
geographic location, and will assess its success at the end of the 2018-19 fiscal year (June 2019) by
determining how many Arizona blood cancer patients were reached through this program.
A survey at the end of the fiscal year will be taken of all recipients, asking specific questions on how the
patients/families have been helped by the funds. The success of the program will be reflected in the survey
results which undoubtedly will show that patients were better able to afford the costs associated with travel to
and from treatment.
8. Identify other organizations, partners or funders participating in the project and their roles.

Gila River Indian Community Grant Application
Grant Cycle 2018
During FY 2017, within the state of Arizona, 142 patients were recipients of Local Travel
Assistance. It is projected that approximately $125,000 will fund local patients, meaning
potentially 250 local patients will be assisted FY 2018. To fully fund a $500 stipend for each of
these patient families, the Arizona Chapter’s goal is to raise $300,000 to serve 600 patients FY
2019 through the Local Travel Assistance Program. As the patient population continues to grow,
so will the need for this assistance. Additional partners on this project would include healthcare
providers throughout the state of Arizona who will work with LLS to ensure that patients are
aware of the Travel Assistance Program through material distribution, consultation and patient
navigation.
Funders within the local community, such as Phoenix Suns Charities, The Thunderbirds,
SRPMIC, Subaru, including GRIC (2015, 2017) have generously committed to our program the
past 3 years. We contine to seek funds from the afroemtioned partners as well as researching
and seeking other local foundations and organizations.
9. Would you be able to implement the proposed plan if your organization received partial funding for this project?
It would be challenging to meet our goal for this particular project of providing assistance to
every Arizona patient family who needs it without full funding, but any funding would help
alleviate the financial burden for however many patients could be served.
10. Describe your plan for project financial sustainability beyond the grant period. If this is a program/project
previously funded by the Gila River Indian Community describe efforts made towards the previously described
sustainability plan.
The annual grants will be used to assist Arizona residents with any and all travel costs related to
their blood cancer diagnosis, including active treatment, lab work and follow up appointments.
Residents may apply for these grants on an annual basis since treatments and follow up for
blood cancers often stretch over several weeks or even months. We plan to continually pursue
funding to provide as much financial assistance as possible.
The Travel Assistance Program Application form must be fully completed by the patient and
health care providers and submitted to AZ LLS. Once approved, funds will be generated and
sent for fulfillment. Funds will be sent directly to awardees as long as funds are available.

Gila River Indian Community Grant Application
Grant Cycle 2018
11. Describe your plan to document progress and results.
LLS will develop a tracking form for all patients including the reason for transportation services with date and
time services are rendered. Tracking will assist in deciding on location factors, patient needs, as well as
assistance implementation for future needs To assess the success of the Patient Travel Assistance Program,
LLS will keep records of the number of patients served, patient demographics, patient diagnoses, and total
patient financial relief provided. The program will be evaluated Outcomes will be measured at the end of LLS’s
fiscal year (6/30).
12. Indicate any application to and/or awards made by a tribe other than the Gila River Indian Community for state
shared revenues for this and any other project for the past five (5) years. If this information is included in a
separate attachment, please indicate that here.
The Arizona Chapter has received the following awards since 2008 from the Salt River-Pima Maricopa Indian
Community:
SRPMIC Funding:
2017 $50,000
2015 $25,000
2014 $50,000
2013 $50,000
2012 $50,000
2011 $100,000
2010 $100,000
2009 $100,000
2008 $100,000
We have indicated an intent to apply with Ft. McDowell, Tohono O’odham, and Yavapai communities this year,
as well.

Gila River Indian Community Grant Application
Grant Cycle 2018
Project Budget
Budget Period: Click here to enter text.
For each budget item listed here please provide a narrative description on the following Project Budget Detail page.
Proposed Budget Expense Amount Amount In Kind Total Budget
(list each budget item) requested from requested or contributions
GRIC secured from
other funders
1. Local Travel Assistance Program $75,000 $225,000 $0 $300,000
2. Project Administration $0 $0 $0 $0
3. Click here to enter text. $0 $0 $0 $0
4. Click here to enter text. $0 $0 $0 $0
5. Click here to enter text. $0 $0 $0 $0
6. Click here to enter text. $0 $0 $0 $0
7. Click here to enter text. $0 $0 $0 $0
8. Click here to enter text. $0 $0 $0 $0
9. Click here to enter text. $0 $0 $0 $0
10. Click here to enter text. $0 $0 $0 $0
11. Click here to enter text. $0 $0 $0 $0
12. Click here to enter text. $0 $0 $0 $0
13. Click here to enter text. $0 $0 $0 $0
14. Click here to enter text. $0 $0 $0 $0
15. Click here to enter text. $0 $0 $0 $0
16. Click here to enter text. $0 $0 $0 $0
17. Click here to enter text. $0 $0 $0 $0
Total Budget $75,000 $225,000 $0 $300,000

Gila River Indian Community Grant Application
Grant Cycle 2018
Project Budget Detail
Please provide a narrative description for each of the project budget items listed on the previous page. Include the
dollar figure and how it was derived.
1. Local Travel Assistance Program
2. Project Administration
3. Click here to enter text.
4. Click here to enter text.
5. Click here to enter text.
6. Click here to enter text.
7. Click here to enter text.
8. Click here to enter text.
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Other explanation: Included is a project budget and budget detail with narrative