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Our Impact
Close Our Impact
Open Our Impact
See how your donations help families, empower children and create brighter futures for children with cancer.
How We Help
Stories
Annual Reports
Programs & Research We Support
Programs & Support
Close Programs & Support
Open Programs & Support
Explore all the ways we’re supporting children with cancer and their families.
Apply for Support
Survivor Scholarship Program
EmPower Pack
Emergency Fund
Benevolent Fund
How to Give?
Close How to Give?
Open How to Give?
Explore ways to donate, fundraise or volunteer, and make a significant impact today.
Plan a Fundraiser
Partner With Us
Events
Donate
Tribute
About Us
Close About Us
Open About Us
Learn how we’ve been shining a light on childhood cancer in Canada since 1987.
Mission & History
Our People
Contact Us
Donate
Search for:
Search
BUILDING BRIGHTER FUTURES BY SUPPORTING DREAMS
Survivor Scholarship Program Application
2025 SURVIVOR SCHOLARSHIP IS OPEN
The portal will be open from March 1st - April 30, 2025
Scholarship Application Form
Step
1
of
6
16%
CAPTCHA
Please confirm you are Human
Applicant Personal Information
Is the applicant a Canadian Citizen or Permeant Resident of Canada?
(Required)
Yes
No
Has the applicant received a scholarship from Childhood Cancer Canada before?
(Required)
Yes
No
What type of scholarship is the applicant applying for?
(Required)
$1,500 - All Streams
$5,000 - Science Technology Engineering, and Mathematics (S.T.E.M.)
Applicant Name
(Required)
First
Last
Applicant Email Address
(Required)
Enter Email
Confirm Email
Applicant Address
(Required)
Street Address
Address Line 2
City
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Postal Code
Applicant Phone
(Required)
Gender
(Required)
Male
Female
Non-binary
Prefer not to say
None of the above
Applicant Date of Birth
(Required)
MM slash DD slash YYYY
Upload a current photo of yourself
(Required)
Max. file size: 300 MB.
Parent / Caregiver information
This section will capture necessary contact details of parent or caregivers of the applicant
Parent Name
(Required)
First
Last
Email
(Required)
Phone
(Required)
Applicant Cancer Details
This section will capture relevant details to the applicants cancer diagnosis and treatment.
Type of Cancer
(Required)
Age at diagnosis
(Required)
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Is the applicant currently being treated for cancer?
(Required)
Yes
No
Which hospital was the applicant primarily treated at
(Required)
BC Children's Hospital - Vancouver, British Columbia
Alberta Children's Hospital - Calgary, Alberta
Stollery Children's Hospital - Edmonton, Alberta
Jim Pattison Children's Hospital - Saskatoon, Saskatchewan
Winnipeg Children's Hospital - Winnipeg, Manitoba
Children's Hospital at London Health Sciences Centre - London, Ontario
McMaster Children's Hospital - Hamilton, Ontario
Children's Hospital of Eastern Ontario (CHEO) - Ottawa, Ontario
The Hospital for Sick Children (SickKids) - Toronto, Ontario
The Montreal Children's Hospital - Montreal, Quebec
CHU Sainte-Justine - Montreal, Quebec
IWK Health Centre - Halifax, Nova Scotia
Janeway Children's Health and Rehabilitation Centre - St. John's, Newfoundland and Labrador
Other
Name of applicant's Oncologist
(Required)
First
Last
Confirmation of cancer diagnosis.
(Required)
Please provided a signed letter on hospital letterhead confirming: Type of cancer, Date of diagnosis, Age at diagnosis, Date of Birth, Name. The document must be signed by your healthcare provider.
Max. file size: 300 MB.
Education Details
This section captures the required details as it relates to the applicants high school and post secondary school details.
High School Information
Please provide details on your High School
School Name
(Required)
Address
(Required)
City
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Graduation Year
(Required)
2025
2025
2024
2023
2022
2021
2026
Is the applicant currently enrolled in a full time Post-Secondary institution?
(Required)
Yes
No
Post Secondary School Information
Please provide details on the Post Secondary school you are or planning on attending.
Post Secondary School Name
(Required)
Program Name
(Required)
Address
(Required)
City
Province
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Current Year of Study
(Required)
Beginning Fall 2025 (Example if it's your first year (Select Year 1)
First year
Second year
Third year
Fourth year
Master
PhD
How many years is the applicant's post secondary program?
(Required)
1
2
3
4
5
6
7
8
More about the applicant
Please provide a description of your cancer journey.
(Required)
Maximum 2500 characters
How will this scholarship alleviate you financially?
(Required)
Maximum 2500 characters
Where did you hear about the Childhood Cancer Canada Survivor Scholarship Program?
(Required)
Social Worker
Medical Professional
Parent
Social Media
Friend
After Care Clinic
Other
Has your family previously accessed any of our other Childhood Cancer Canada programs (please select all that apply)
(Required)
EmPower Pack
Emergency Funds
Parent/Caregiver Support Group
None that I am aware of
Are you interested in being a Childhood Cancer Canada Ambassador?
(Required)
Yes
No
Media Release Form Authorization to use Written Materials/Photograph
(Required)
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.
Yes
No
Terms and Conditions
(Required)
This form is designed for collection of personal information to asses the eligibility of an individual for the Childhood Cancer Canada Survivor Scholarship Program. Personal information including medical details and government ID is required. By continuing you agree to allowing Childhood Cancer Canada to capture, store and use this information for the sole purpose of administering the Scholarship Program.
I agree to the terms and conditions.
Name
This field is for validation purposes and should be left unchanged.
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