Scientist↔Survivor Program (SSP) at the 2018 AACR Science of Cancer Health Disparities Conference Past Participant Application

Applicant Information.

Please complete this application in its entirety including the advocate poster section. The application deadline is July 23, 2018. Applicants will be notified of their status by end of August.

Please note, you cannot save your application online. Applications must be completed in one sitting. Please review the application questions in the pdf. document prior to completing the application.

Incomplete applications will not be considered.

Question Title

* 1. Applicant

Name *

Organization

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Country

Email Address *

Phone Number

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* 2. Please indicate your current organ site/focus of your advocacy: Check all that apply.

All cancers

Brain cancer

Breast cancer

Colon & rectum cancer

Gastrointestinal cancer

Head & Neck cancer

Kidney cancer

Leukemia / Lymphoma

Liver cancer

Lung & Bronchus cancer

Melanoma

Multiple Myeloma

Ovarian cancer

Pancreatic cancer

Pediatric cancer

Prostate cancer

Reproductive cancer

Sarcoma & Soft Tissue cancer

Skin cancer

Stomach cancer

Thyroid cancer

Uterine Cervix

Uterine Corpus

Other (please specify)

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* 3. What year(s) did you participate in SSP at The Science of Cancer Health Disparities?

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* 4. Have you attended other advocacy training or mentorship programs since attending SSP?

Yes

If yes, please list the program(s) you have attended.

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* 5. Please provide a brief (no more than 250 words) narrative biography describing your involvement in cancer-related advocacy. Please do not list your accomplishments.

Question Title

* 1. Applicant

Question Title

* 2. Please indicate your current organ site/focus of your advocacy: Check all that apply.

Question Title

* 3. What year(s) did you participate in SSP at The Science of Cancer Health Disparities?

Question Title

* 4. Have you attended other advocacy training or mentorship programs since attending SSP?

Question Title

* 5. Please provide a brief (no more than 250 words) narrative biography describing your involvement in cancer-related advocacy. Please do not list your accomplishments.

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* 6. What are your current and upcoming advocacy priorities and plans for 2018-2019? Please limit your response to 250 words.