State/ Province / Region
Postal/ Zip Code
*Max 2 MB image allowed. Only jpg format accepted.
*Only PDF files (Max 2 MB) are accepted. If you need clarification on what a current family doctor or Oncologist statement looks like, please refer to our FAQ section above.
In order to receive your scholarship cheque you must provide your SIN #, as a T4 will be issued for tax purposes.
|Have you ever received this Childhood Cancer Canada scholarship in the past? *:
Please note, this scholarship program is a one-time award.
|Are you enrolled in full-time post-secondary institution?:
(University, college, or vocational training program)*
Expected Graduation Year*
Write a 500-word personal statement that highlights your personal cancer journey, desired educational path, and career plans. Please also include any challenges you have faced financially and how this scholarship will impact you and your family.
|Are you a Canadian Citizen?:
|Would you like to sign up for our newsletter?:
Stay up-to-date on Childhood Cancer Canada's latest news, articles, updates, resources, and exclusive content!
|I agree to the statement below.*:
I, hereby authorize Childhood Cancer Canada to use, reproduce, and/or publish all written and/or visual materials, including photographs that may pertain to me. I understand that this material may be used in various publications, public affairs releases, recruitment materials, and/or for other related endeavors. This material may appear on the Foundation's website, as well a full list of the survivor scholarship recipients will be made available on CCC's website. A notification that I have received a Childhood Cancer Canada scholarship may appear in my local newspaper*. This authorization is continuous and may only be withdrawn by my specific rescinding of this authorization. Consequently, Childhood Cancer Canada may publish materials, use my name (first name only), photograph, and/or make reference to me in any manner that the Foundation deems appropriate in order to promote/publicize service opportunities.
By signing the space above, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.