STEP 1: Print Physician’s Verification form (download and print now) and have your physician’s office complete. You cannot proceed forward with online application until it is completed, signed, scanned and uploaded before STEP 2.

STEP 2: Complete ALL sections of the Pink Assistance Fund (PAF) Application Form

STEP 3: Complete and sign the Release & Authorization

STEP 4: Complete and sign the Story Release

STEP 5: Upload proof of Loudoun County residency (either copy of state issued ID,
driver’s license or bill in YOUR NAME with Loudoun County address on it)

STEP 6: Upload copies of bills you would like to submit for financial consideration.
Limit to no more than five.