TELL US YOUR STORY - So we can share it.

Spotlight Hope represents the collective wisdom of families that have been affected by Pediatric Cancer. It is our goal that knowledge and wisdom from the 20/20 hindsight which is born from having lived through the ordeal of Pediatric Cancer will become a beacon of hope full of practical real world advice for families just entering their own crisis.

Please take a moment to share with us your experiences and insights as you reflect on the resources that were of the greatest help to your child and your family as well as the missing resources that you wish you could have had at any critical moment.

Your contribution to this project is greatly appreciated and will also be kept in strict confidence. Before the results of Spotlight Hope are published, you will be given the opportunity to be listed as a contributor or to remain anonymous.

Please make sure to give us the best contact information so that we may contact you before final publication and/or if necessary clarify any advice for others you wish to share.

A thousand times - thanks!

Amy and Jeremy Jacobs

Contact Full Name *

Email *

Address

Mobile *

Other Phone (home) *

Preferred Method of Contact

Would you be willing to be interviewed or have your story put on video or print?

If you are not the Mother or Father, please indicate your relationship with the Child diagnosed with cancer.

What type of cancer was your child diagnosed with?

If Other - please indicate

At what age was your child diagnosed with cancer?

If your child is a survivor, what is your child's current age?

1. What were the top two to five questions you had immediately upon diagnosis, and do you feel that you had adequate access to those answers?

2. Which institutions or organizations became your most important resources or pillars of support, and why?

3. What resources or support do you wish you would have had, but did not?

4. What are the top two to five pieces of advice that you would give parents or caretakers of a child that has just been diagnosed with cancer?

5. If you have other children, what were the top ways that you believe they were impacted; and what resources either helped or would have been nice?

6. What were the most valuable ways your family and friends offered support, and in hindsight what would you ask your family and friends to do differently?

7. Are you interested in becoming a Mentor?

8. If your child is still undergoing treatment, please indicate whether you would like to receive an application for Mentoring or Financial Support?

Feel free to add any additional notes here

Type of Treatment [select all that apply]

Bone Marrow Transplant

Donor Search

Donor Harvest

Other Cancer Treatment/Procedures

Pharmaceuticals/Supplies

Languages Spoken

How did you hear about BraveHearts for Kids?

Why do you want to volunteer to be a Mentor?

How many hours are available per week to volunteer?

Conditions of submission

I hearby confirm that the information provided in the above web application form is true and complete to the best of my knowledge. I understand that providing false information may disqualify me from consideration as a volunteer. My act of filling out the aforementioned form gives my consent to perform a background check. I will consider all information that I gain in my volunteer position to be confidential. I understand that my volunteer service will be terminated in an event of breach of confidentiality.