CancerEVOLVE Intimacy-Informed Care Essentials Pilot: Founding Partner Application
Share details about your organization and your interest so we can assess fit for the November 2026–January 2027 pilot.
Full Name
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Job Title/Role
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Organization
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Email Address
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example@example.com
Organization Website
City, State/Province, and Country
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Which best describes your organization or program?
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Cancer center or hospital-based cancer program
Community cancer organization
Cancer support nonprofit
Survivorship program
Psychosocial oncology program/team
Patient navigation or support program
Other
Briefly tell us about the program or team that would participate in the pilot and the people you serve.
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Approximately how many staff members would you expect to participate in the training?
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1–5
6–10
11–15
16–20
21–25
More than 25
When a patient raises a concern related to intimacy, sexuality, body image, or relationships, what typically happens within your organization now?
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What would you most like to strengthen or better understand about how your organization addresses these concerns?
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Why are you interested in participating in the CancerEVOLVE Essentials Pilot at this time?
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Is there someone within your organization who can serve as the primary contact and help coordinate the pilot?
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Yes
No
Not sure
Their name
First Name
Last Name
Which timeframe would be most feasible for your organization?
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November/December 2026
January/February 2027
March/April 2027
Flexible across these dates
The Founding Pilot Partner Fee is $2,950. If your organization is selected and we mutually determine that the pilot is a good fit, is this fee feasible for your organization?
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Yes
I believe so, but would need internal approval
I’m not sure and would like to discuss it
No
Is there anything else you would like CancerEVOLVE to know about your organization or your interest in the pilot?
I understand that submitting this application does not commit my organization to participating in the pilot. Potential pilot partners will be invited to a brief conversation with CancerEVOLVE before participation is confirmed.
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I acknowledge and understand
Submit Application
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