CIBC Foundation Survivor Scholarship


Survivor Scholarships Application Form

Reminder: Applications are due 11:59 p.m. April 30th, 2024. Apply now!

Please complete the form below and ensure your entry is correct and properly formatted. If you are selected to advance to the next stage of the application process, you may be asked for additional supporting documentation. We will evaluate your initial application and will contact you as needed based on the information you provide below. 

Childhood Cancer Canada is committed to providing all childhood cancer survivors the equal opportunity to pursue their post-secondary academic aspirations. We do not discriminate against any application based on race, colour, religion, gender, age, national origin, disability, marital status, or any other protected class.

Applications submitted after this time will not be considered. Once an application has been submitted, it cannot be revised.  

Enter a valid date of birth. The format should be MM/DD/YYYY (e.g. 01-12-2008)
Region ie Durham, Peel, York etc
*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. Please Note: Applications that do not contain the family doctor or Oncologist statement will be rejected as incomplete.
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)*
Are you currently accepted or enrolled in the program?:

ex: Year 1
ex: 4 years
(Nursing, Science, Business, Marketing, Engineering, etc. )
Mandatory- Write a max 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. Do not include experiences or skills that aren’t relevant to the application.
Mandatory- 500 or less -word essay. Do not include experiences that aren’t relevant to the application.
Are you a Canadian Citizen?:

Would you like to sign up for our newsletter?:

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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.

Survivor Scholarship Testimonials