Applicant’s Personal Information
I am applying for*:
Social Insurance Number*
In order to receive your scholarship cheque you must provide your SIN #, as a T4 will be issued for tax purposes.
State/ Province / Region
Postal/ Zip Code
Video or Written Statement*
As part of your scholarship application please send us a 2-3 minute video describing your personal life experience, your future goals, and why you are applying for this scholarship.
If you are unable to upload a video, please use the written option. You may also reach out to [email protected]
to coordinate sending the video by other means and note this in the personal statement.
Family Information (Parent or Guardian)
Have you ever received this Childhood Cancer Canada scholarship in the past? *:
Please note, this scholarship program is a one-time award.
Full-time post-secondary institution (university, college, or vocational training program)*:
High School Information
Expected Graduation Year*
Media Release Form
Authorization to use Written Materials/Photographs
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This authorization is continuous and may only be withdrawn by my specific rescinding of this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,
photograph, and/or make reference to me in any manner that the Foundation deems appropriate in order to promote/publicize service opportunities.
WE NEED YOUR HELP!
Do you know that your scholarship is funded by the generosity of donors? We rely on the kindness of many donors to support the programs we deliver, including the Survivor Scholarship Fund. Fundraising is vital to program delivery and that’s where you come in.
Importance of Fundraising for Childhood Cancer Canada
Childhood Cancer Canada is focused on saving, enhancing, and extending the lives of children with cancer.
We are the founding funding partner of the C17 Council, an organization composed of institutionally appointed heads of the seventeen pediatric hematology, oncology, and stem cell transplant programs across Canada. Current research being conducted by the C17 includes a focus on the long-term effects of childhood cancer treatments. The hope is that through this research we will be able to determine the factors that influence potential post-treatment physical, social, and cognitive effects as well as the occurrence of secondary cancers.
Our funds also support families through programming. We offer various programs to help navigate the different stages of childhood cancer, such as our emPower Pack Program, Amazing Adventures, Sibling Support, School Resources, Survivor Scholarship, and Benevolent Fund. These programs provide much needed resources not only to the child with cancer, but to the family as a whole.
CCC needs your help to continue funding this life saving research and supportive programming. We ask you to consider giving back by becoming an Event Organizer
, at your school or in your community, and help conquer childhood cancer. Please contact us so that we can help you become a successful
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