Shine Cancer Support

Network Leader Application Form

Full Name:

DOB:

Age:

Sex:

Have you been diagnosed with cancer? Please tell us when and what type of cancer you were diagnosed with.

Tell us where you are in your treatment plan

Have you attended a Shine event? (Y/N)

If yes, what was it and when?

Are you able to commit 5-8 hours per month to being a Shine Network Leader for the next two years? (Y/N)

Which area would you like to be a Network Leader for?

Do you have an educational/professional background in any of the following areas?(please tick)

Therapy (type)Social workNursing

Psychology/CounsellingHealth promotionDigital media

Art therapyVolunteeringEvent planning

  1. Please tell us a bit about your cancer experience (1 – 2 paragraphs; e.g., diagnosis, treatment (type/ length), where you received treatment; relapse?; how it impacted your life, major challenges, major sources of strength, etc.)
  1. It is important that our Shine Network Leaders are in a place of peace and acceptance with their personal cancer experiences. Please tell us about you’ve dealt with your diagnosis and what has supported you through your experience.
  1. Please let us know why you’re applying for this opportunity. What makes you want to be a Shine Network leader?
  1. Please tell us a little bit about what you’re up to these days (e.g., time commitments related to school, work, family, adventures, volunteering, etc.).
  1. Do you have any experience relevant to this position (e.g., health care, volunteering, raising public awareness, fundraising, etc.)?
  1. The major focus for this position will be on arranging events for your Network and bringing young adults living with cancer together to enjoy fun activities and social time. This involves working independently and taking initiative in planning/promoting events. Examples of Shine Network activities include evening drinks, coffees, walks, bowling etc. Please tell us why you think you’d be great at coordinating this (e.g., group facilitation skills; recreation interests/skills; outgoing personality; organisational skills; computer skills; social media skills; etc.).
  1. We will also be asking our Shine Network Leaders to build and nurture relationships between Shine, health professionals, and the larger cancer community. This may involve connecting with health professionals to tell them of our programmes, or helping out with fundraising and national events. Please tell us why you think you’d be great in this role (e.g., well-connected in your community; fundraising experience, etc.).

Your Contact Information:

Phone Number:

Email Address:

Mailing Address:

Please provide us with a reference (If possible, please choose a reference who has a professional role related to your cancer – e.g., social worker, nurse, oncologist, someone who works at a cancer organisation; support group coordinator, etc.)

Full Name:

Organisation/institution:

Role:

Phone Number:

Email Address:

How long has this person known you and in what capacity?