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CancerCon Patient Scholarship Application for Pediatric & Teen Survivors
Travel Scholarships are being offered to survivors who would like to participate in a Patient Forum for Pediatric & Teen survivors at CancerCon 2017, April 27 - April 30, 2017, in Denver, Colorado. Travel Scholarships includes free registration, airfare and hotel for up to 3 nights. The focus group will be held Friday, April 28th.

To be eligible for this scholarship, applicants must meet all of the below requirement criteria

Requirements:
-- Diagnosed before 18 years of age (any type of cancer diagnosis)
-- Current Age between 18 & 35
-- Experiences some long term side effects
-- Must live in the United States

Applications are due: March 26, 2017

Email award@stupidcancer.org with questions.

First Name
Last Name
Street Address
City
State
Zip
Phone Number
Email Address
Current Age (must be between 18-35)
Age at Diagnosis (must be before age 18)
Have you registered for CancerCon?
Type of cancer diagnosed with?
What is your survivorship story?
Please describe your story (cancer type, date & age of diagnosis) and how it has affected you. (Limit 2000 characters)
Are you still in treatment? If so, what type of treatment are you receiving?
Please list any long term side effects that you have experienced.
How do you think you will benefit from attending CancerCon?
(Limit 2000 characters)
What hospital were you treated?
How did you hear about this scholarship?
Have you attended a previous Stupid Cancer conference? If so, please select which conferences attended.
Submit
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