Caregiver Coach Application

Caregiving to a cancer patient can be challenging and rewarding. Often the Caregiver needs more support than the patient as they struggle. Strong Caregivers who have successfully cared for patients and are willing to share their wisdom and knowledge may apply to be a Caregiver Coach. Your application will be reviewed and you will be contacted by our Caregiver Coach Coordinator to be interviewed and to discuss the next steps in the process.

Fields marked with an asterisk * are required.

Personal Information

About You

Your The patient's biologically assigned gender *

Contact Methods

Residential Address

Caregiving Experience

Answering these questions will enable us to place you most effectively with caregivers that are having similar experiences to yours.

What types of treatment have you  has the patient received as part of your  their care? *
Stage/grade of cancer *

Activities & Involvement

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

What are your main areas of interest, or main strengths? *
Are you a current Roswell Park volunteer? *

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