Mentor Application
 
 
            
Notification
       
  Thank you for your interest in volunteering to mentor teens with cancer from across Canada through Teen Connector. The Childhood Cancer Foundation - Candlelighters Canada defines a mentor as a cancer survivor who has been through a childhood cancer experience and is post treatment. As a mentor your personal experience as a cancer survivor is invaluable to teens who may be feeling overwhelmed, vulnerable and alone. Teens will look to you for support, advice, and motivation as they progress through their journey. Of course each person's experience is unique and any medical questions should be re-directed to an oncologist or doctor.

Kindly respond to the following questions to let us know about yourself. We really appreciate your interest and will get back to you soon. Please note that several fields filled out below will become part of your permanent public profile and you will be unable to make changes upon acceptance without permission from Teen Connector. Also be advised that a valid, up to date Police Check will be required in order to further participate in training, and mentoring. Please note that there are only limited number of positions.

If you are not selected as a mentor at this time, but you are a teenager, we encourage you to register and become a member of Teen Connector as your active participation will be beneficial to you and other users.
 
   
   
   
   
   
   
   
   
   
       

Basic Information
Okay, let's get started.
First Name*:     Last Name*:    
       
Email (Username)*:           
       
Password*:     Password confirm*:      
       
Gender:
   
       
Birth Date*:    
       
Home Town:    
       
Cancer Experiences

Your answers to the information below tells us about your cancer experience and should you be selected as a mentor, it will help us link you with teens who will look to you for support.
     
Type of Cancer:    
       
Sub Categories:  
       


Specific Initial Diagnosis:
Age at Initial Diagnosis:
What was the main hospital you were treated in?
What was the name of your primary oncologist?
Please check off all that you experienced during your cancer journey.
PROCEDURES:________________________________________________________________________
     
   
   
   
   
       
HOSPITAL STAYS:____________________________________________________________________
       
   
   
   
 
       
SURGERY:____________________________________________________________________________
       
   
       
TREATMENT:_________________________________________________________________________
       
   
   
   
   
   
       
PHYSICAL CHANGES:_________________________________________________________________
       
   
   
   
   
   
       
EMOTIONAL CHANGES:________________________________________________________________
       
   
 
       
SCHOOL EXPERIENCE:________________________________________________________________
       
   
   
 
       
TREATMENT COMPLETION:____________________________________________________________
       
How long did your treatment last?       
 
Based on the items you checked off above what were some of the challenges you faced in each topic?
 
Procedures
 
Hospital Stays
 
Surgery
 
Treatment
 
Physical Changes
 
Emotional Changes
 
School Experience
 
 
Why do you want to be a mentor to teens experiencing cancer?
 
 
Personal Information
Tell us a little about your interests and what you do during your spare time.
What are you doing now? (work, school, spare time activities):
 
Favourite Things To Do



Favourite Music



Favourite TV Shows



Favourite Movies



Favourite Books



Favourite Quotations



About Me Tidbits



Who do you admire?



       
Contact Information
We may need to contact you other than by email.
Mobile Phone: Home Phone:
       
Address: City / Town:
       
Province: Postal Code:
 
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Please Note: This site has been designed for you but we'd appreciate your feedback. Don't hesitate to send us your ideas and suggestions: tcteam@childhoodcancer.ca.
 
 

 

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