Cancer Coach Application

Complete this application if you are interested in being a Cancer Coach. Your application will be reviewed and you will be contacted by our Cancer Coach Coordinator to be interviewed and to discuss the next steps in the process.

Personal Information

About You

Your The patient's biologically assigned gender *

Contact Methods

Residential Address

Treatment Information

Answering these questions about your treatment will enable us to place you most effectively with patients that are having similar experiences to yours.

Have you had any recurrences? *

Stage *

What types of treatment were involved in your care? *

Activities & Involvement

Answering these questions about your volunteer experience and hobbies will enable us to place you most effectively with patients that are having similar experiences to yours.

By checking this box to apply to be a participant in the Roswell Park Comprehensive Cancer Center’s Cancer Coach program, you acknowledge giving authorization for the program administrators to share basic demographic information with matched participants and partners of the program to support your needs.