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 director, Madison Seguin, at info@jointhejourney.us or by calling 507-206-3212.
Sign in to Google to save your progress. Learn more
Email *
Demographic Information
First Name *
Last Name *
Preferred communication method *
Required
Phone Number
When is the best time to reach you? *
Date of Birth *
MM
/
DD
/
YYYY
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? *
How many hours each week do you expect to dedicate to volunteering? *
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? *
How long have you been out of treatment? *
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms