Join the Journey Support Person Application
Thank you for your interest in supporting women and men diagnosed with breast cancer. If you have been diagnosed with breast cancer and would like to support those affected by breast cancer, please complete this application.

If you have any questions, please contact our program coordinator, Madison Seguin, at info@jointhejourney.us or by calling 507-206-3212.
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Email *
Demographic Information
First Name *
Last Name *
Preferred communication method
Phone Number
Date of Birth *
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DD
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Current Occupation
Previous Volunteer Experience
Languages spoken
Experience
Tell us about your feelings and experiences immediately following your diagnosis. *
What do you hope to contribute when supporting individuals affected by breast cancer? *
What do you hope to receive through providing support? *
Is there anything else we should know about your experiences with cancer? *
Do you have any questions about Join the Journey or the various support groups we have?
Diagnosis
You will be asked to provide support based on your diagnosis and your experience with breast cancer. Providing us this information can best assist us in getting you in touch with the correct support group leaders.
Year of Diagnosis *
Age at Diagnosis *
What was you marital status and/or living situation when you were diagnosed?
What was your support system through cancer treatment?
If you had children when diagnosed, how old were they?
Type of Breast Cancer
Where did you receive treatment?
Did you undergo Chemo therapy?
Clear selection
What type of chemo did you have?
Did you receive anti her2 infusions? Check all that apply.
What type of surgery did you have? *
Required
Did you have Radiation? *
Hormone Status (Check all that apply) *
Required
Anti Estrogen Therapy (Check all that apply) *
Required
Did you have reconstruction? (Check all that apply) *
Required
How long have you been out of treatment? *
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