Individual Grant Application

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

Put NA if you don't have one.

What do you know about Compete for a Cure?

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

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

What stage were you diagnosed?*

How long ago were you diagnosed?*

Was there a second diagnosis?

How long ago was your second diagnosis?

Treatment Options:*

Local TreamentsSystemic TreatmentsCommon TreatmentsOther

Please provide treatment locations:

Lumpectomy:

Are you currently in treatment?

YesNo

Does your primary care doctor and /or oncologist support your Health goals: nutrition, movement, and training goals?*

File Upload*

How would you score your overall health?

How would you score your overall mental/emotional health?

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?

Have you every seen a mental health professional before?

YesNo

Is there a family history of mental illness?

YesNoUnsure

Are you currently seeking therapy with a mental health professional?

YesNo

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?

How would you score your overall movement?

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?

Where do you prefer to engage in your physical activities?

Please fill in the email of your coach, trainer, therapist if you are ok with us checking in and doing any follow ups: Put NA otherwise*

example@example.com

Do you wish there was more information on anything specific in regards to health and wellness for yourself? 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 PER MONTH membership expenditures, including both current and anticipated expenses that you are applying for*

List out estimated health & wellness expenses (ie CF $150, Personal Training $200, Nutrition Coach $75)

What is the TOTAL amount for 1 month of financial assistance you are seeking to support your health and wellness needs:*

This will NOT include HSN Nutrition Coaching or MentalFit Mindset Coaching Scholarship Programs; which are separate. Our goal is to provide at least 3 months of support, please just enter 1 month total above.

Do you want to include the HSN 12-Week Nutrition Coaching with this?

Yes, add nutrition coaching to my total aboveNo Thanks

Do you want to include the 12-week MentalFit Mindset Coaching program with this?

Yes, add MentalFit coaching to my totalNo

Do you want to include the 12-week 1on1 Personal Training program with this?

Yes, add 1on1 Training to my totalNo

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

When requesting a grant for 1-on-1 training, it is our policy to prioritize safety and effective care by recommending that all sessions be conducted with a certified Cancer Exercise Specialist. These professionals are specifically trained to address the unique risks and considerations associated with cancer recovery and survivorship, ensuring that exercise programs are both safe and beneficial. If you are seeking 1-on-1 training services, we can provide recommendations for certified Cancer Exercise Specialists (CES) to ensure your safety and the effectiveness of your program.

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.

US Applicants- Please ensure you enroll your cell phone or email in Zelle to accept Grant payments. Zelle is free and a safe way for us to transfer your grant.

Non US Residents- Please prepare to provide your SWIFT Bank Account # and Routing number. This will speed up the wire transfer process.

Grant Applications currently take approx 4-6 weeks for review and processing. In addition to our Scholarship Programs, we aim to provide a minimum of 3 months of financial support and meet you wherever you are in your journey.

Fill in payment info based on requirements above.

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Diagnosis Information

Please mark all treatments or therapy you have had:

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Health & Wellness Details

Grant Financials