Acute Lymphoblastic Leukemia (ALL) CancerCon Patient Scholarship Application
Travel Scholarships are being offered to patient/survivors who would like to participate in a Patient Forum for Acute Lymphoblastic Leukemia (ALL) at CancerCon 2017, April 27 - April 30, 2017, in Denver, Colorado. Travel Scholarship 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:
-- Acute Lymphoblastic Leukemia (ALL) Survivor/Patient
-- Currently in treatment or finished treatment within four years
-- 14 - 30 Years of Age (Patients under 18 will be required to travel with a parent)
-- 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 14-30) *
Age at Diagnosis *
What is your survivorship story? *
Please describe your story (cancer type, date & age of diagnosis) and how it has affected you. (Limit 2000 characters)
How do you think you will benefit from attending CancerCon? *
(Limit 2000 characters)
Are you still in treatment? If so, what type of treatment are you receiving? *
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. *
Have you registered for CancerCon? *
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