Individual Grant Application

Get Support

Our efforts are centered around health, fitness, and community; all of which play a vital role in empowering those who have been affected by a cancer diagnosis. Fill out the application below to receive financial support.
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Instagram Handle
What do you know about Compete for a Cure?
Did you subscribe to the Compete for a Cure Emailing list?

YesNo
Would you be willing to share your story/journey with the Compete for a Cure Community?

YesNo
Do you know about our Boob University?

YesNo
Would you be willing to learn more about our Free Course: Breast Cancer Basics for Coaches?

YesNo
Would you be willing to learn more about our Free Course: Breast Cancer Basics for Women?

YesNo
Do you have an interest in becoming a mentor to other survivors?

YesNoMaybe
Diagnosis Information
What stage were you diagnosed?*

Stage 0Stage 1Stage 2Stage 3Stage 4
How long ago were you diagnosed?*
Was there a second diagnosis?
How long ago was your second diagnosis?
Please mark all treatments or therapy you have had:
Treatment Options:*

Local TreamentsSystemic TreatmentsCommon TreatmentsOther
Please provide treatment locations:
Lumpectomy:
Are you currently in treatment?

YesNo
Does your primary care doctor and Oncologist support your Health goals: nutrition, movement and training goals?*
Upload Below

A signed and dated letter (on letterhead) verifying your diagnosis and detailing your current and upcoming treatment plan from one of the following: Oncologist, Licensed Social Worker, Professional Patient Navigator, Nurse Navigator, etc.
File Upload*

Cancelof
Health & Wellness Details

Our goal is to meet you where are you and help provide additional resources.
How would you score your overall health?

1

2

3

4

5

6

7

8

9

10

1 is Worst, 10 is Best
How would you score your overall mental/emotional health?

1

2

3

4

5

6

7

8

9

10

1 is Worst, 10 is Best
Please provide what type of therapy you receive if any: (this can be any type of therapy)
Have you ever worked with a nutrition coach or dietitian?

YesNo
Do you use technology to track your nutrition (e.g.myfitnesspal, MacroStax)?

YesNo
If you are not or have never been on a nutrition plan, what was your barrier and what do you currently struggle with:
How would you score your nutrition?

1

2

3

4

5

6

7

8

9

10

1 is Worst, 10 is Best
Do you get any current professional treatment or coaching for your movement or recovery?

YesNo
Are you currently physically active?

YesNo
How would you score your overall physical health?

1

2

3

4

5

6

7

8

9

10

1 is Worst, 10 is Best
How would you score your overall movement?

1

2

3

4

5

6

7

8

9

10

1 is Worst, 10 is Best
Health & Wellness Preference: (Boot Camp, Yoga, Hyrox, Spartan, CrossFit, etc)
Did you start working out before or after your diagnosis?

BeforeAfter
How long have you been consistent with your workouts?
What are your current barriers to not being physically active, if any?
How much time each day can you commit to your physical activity?
Where do you prefer to engage in your physical activities?
Please fill in your coach, trainer, therapist email here if you are ok with us checking in and doing any follow ups:*
example@example.com
Do you wish there was more information on anything specific in regards to health and wellness? Whether it be local resources, online education, tips, etc.*
If we are aware of the community's requirements, it enables us to prioritize specific education and allocate resources accordingly.
Please provide a breakdown of your monthly membership expenditures, including both current and anticipated expenses*
List out estimated health & wellness expenses (ie CF $150, Personal Training $200, Nutrition Coach $75)
What amount of financial assistance are you seeking to support your health and wellness needs:*
Do you want to include the HSN 12-Week Nutrition Coaching with this?

Yes, add nutrition coaching to my total aboveNo Thanks
Lastly, please tell us why you are applying for a Grant, what the funds will go towards, and how it will help you: *
The more details the better
In the event that we find any falsified information on your funding application or any deliberate omission related to Compete for a Cure Fund's definition of active treatment, you will be obligated to promptly reimburse Compete for a Cure for any payments that were provided on your behalf. Moreover, Compete for a Cure reserves the right to suspend any further payments that may have been previously awarded to you.
Should be Empty:

Get Support

Diagnosis Information

Please mark all treatments or therapy you have had:

Upload Below

Health & Wellness Details