2025 West Coast Conference Technology Assistance Program

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Saving Your Application

We wouldn't want you to lose any of your time or effort filling out this application due to an unexpected internet outage, browser error, or if you have to step away before completing and submitting.

The following instructions will show you how to save your application as you go. There are options presented for saving on a desktop computer / laptop or via mobile phone. Be sure to read your relevant section in full before moving through the steps.

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Saving (on a desktop computer / laptop)

At the bottom of this page, you should see an icon that looks like this:

Clicking that icon will let you save your application.

A prompt will then ask you to login via Google or Facebook, or to "Sign up with Email". We recommend you instead click the option at the very bottom, which is a link that reads "Skip Create an Account".

Then type in your e-mail address and hit "Send". You will be e-mailed a link (which is unique to you) that you can click to return to your application at any point if you cannot complete it now.

NOTE: When you return to your application, it will take you back to the beginning - but use the green dots at the bottom of the screen to skip forward to where you left off.

As you move through the application, a green arrow will show on top of the save icon to confirm your work is being saved. It will look like this:

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Saving (on a mobile phone / tablet)

At the bottom of this page, you should see an icon that looks like this:

Clicking that icon will let you take you to the following page. Clicking the circled icon will let you save your application.

A prompt will then ask you to login via Google or Facebook, or to "Sign up with Email". We recommend you instead click the option at the very bottom, which is a link that reads "Skip Create an Account".

Then type in your e-mail address and hit "Send". You will be e-mailed a link (which is unique to you) that you can click to return to your application at any point if you cannot complete it now.

NOTE: When you return to your application, it will take you back to the beginning - but use the arrows at the bottom of the page to scroll through to where you left off.
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Terms and Conditions* This field is required.Please review and agree to our Terms & Conditions at the following link.
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Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
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Phone Number* This field is required.
Please enter a valid phone number.
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Address* This field is required.
Street Address
Street Address Line 2
City
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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Date of Birth (MM/DD/YYYY)* This field is required.
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I am a:* This field is required.Please note: This program is only open to patients and survivors diagnosed with cancer.
Patient/Survivor
Patient/Survivor AND a healthcare professional (nurse, social worker, navigator, doctor, etc.)
Patient/Survivor AND a nonprofit professional
Healthcare professional ONLY (nurse, social worker, navigator, doctor, etc.)
Nonprofit professional ONLY
Other
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I am:* This field is required.Please note: This program is only open to patients and survivors diagnosed with cancer.
Just diagnosed, pre-treatment
In-treatment (1 year or less)
In-treatment (1 year - 3 years)
In-treatment (3 years - 5 years)
In-treatment (5 years or more)
Post-treatment (5 years or less)
Post-treatment (5 years or more)
Not diagnosed
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Are you currently pursuing a degree full or part time?For example: Associates, Bachelors, Masters, etc.
YESNO
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Cancer Diagnosis (select all that apply)* This field is required.
Bladder
Blood (leukemia, lymphoma, multiple myeloma)
Breast
Colorectal (colon, bowel, rectal)
Endocrine (thyroid, parathyroid, pituitary, islet cell, adrenocortical carcinoma)
Eye (retinoblastoma, intraocular melanoma)
Gastrointestinal (esophagus, stomach, liver, gallbladder, pancreas, GIST)
Gynecologic (ovarian, uterine, vaginal, vulvar, fallopian tube, cervical, endometrial, gestational)
Head and Neck (laryngeal, lip & oral cavity, mouth, throat, pharyngeal, sinus & nasal cavity)
Kidney
Musculoskeletal (bone, soft tissue sarcoma, Ewing sarcoma)
Neurologic (brain, neuroblastoma, spinal cord)
Penile, prostate, testicular
Respiratory (lung, mesothelioma, thymoma, thymic carcinoma)
Skin (melanoma, Kaposi sarcoma)
Unknown origin
Other
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Which of the following best describes you?* This field is required.
Woman
Man
Non-binary
Agender
Gender fluid
I don't know/I am not sure
Prefer not to answer
Other
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Are you transgender?* This field is required.
Yes
No
Prefer not to answer
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What are your pronouns?* This field is required.
She/Her
He/Him
They/Them
Ze/Zir
Ze/Hir
Prefer not to answer
Other
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Are you Hispanic, Latine, or Spanish descent?* This field is required.
Yes
No
I don't know
Prefer not to answer
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Which of the following best describes your race / ethnicity? (select all that apply)* This field is required.
Asian or Asian American
Black or African American
Hispanic, Latine, or Spanish origin
Middle Eastern or North African
Native American or Alaska Native
Native Hawaiian or Other Pacific Islander
White Non-Hispanic
Prefer not to answer
Don't Know
Other
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Do you speak any languages besides English fluently?* This field is required.
No
Prefer not to answer
Other
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Have you ever served in the U.S. military or military reserves?* This field is required.
Yes
No
Prefer not to answer
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Please choose the option(s) that best reflect your ability status. We are interested in this identification regardless of whether you typically request accommodations. (select all that apply)* This field is required.I describe myself as a person:
With vision loss/low vision or who is blind
Who is hard of hearing or deaf
Who uses a wheelchair, crutch, or other assistive mobility device
With a brain injury or other acquired cognitive disability
A disability not listed above
I do not identify as a person with a disability
Prefer not to answer
Other
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Employment Status* This field is required.
Employed full-time
Employed part-time
Self-employed
Employed full-time but looking for a new job
Employed part-time but looking for a new job
Unemployed, looking for full-time work
Unemployed, looking for part-time work
Neither employed nor looking for work
Retired
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Current or Former Job:
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How would being granted a 2025 West Coast Conference Technology Assistance Program award make a difference in your life and work circumstances right now?* This field is required.For example: could having better access to technology help you with work, remote work, a job search, telehealth doctor visits, etc.? If you currently have an older device, borrowed device or only have a device provided by your workplace, how could a new one benefit you?
Huge
Large
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Small
Ok
Ok
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Do you have access to any of the below at home? (select all the apply)* This field is required.Please use the "Other" field below to provide any important additional context, such as if your devices are employer-owned, or borrowed / not directly owned by you.
Desktop computer
Laptop, notebook or Chromebook (any brand)
Tablet (a portable computer with touchscreen, such as iPad or Amazon Fire)
Smartphone
Do not have this kind of technology at home
Other
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Do you have internet access in your home? (select all that apply)* This field is required.If you do NOT have internet access in your home, please use the "No" field below to let us if you use any alternate method for accessing the internet, such as a library, community center, or someone else's home.
Yes, through an internet provider
Yes, through data on a smartphone or tablet
Other
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Are you able to access the internet to attend the West Coast Conference on Work and Cancer on Saturday, October 25, 2025 from 9:00 AM to 4:00 PM (Pacific Time)?* This field is required.Please note: All award recipients are expected to attend the entire conference. However, please contact us directly if this poses an undue hardship (such as work or treatment schedules).
YESNO
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What is your current work situation, and how has cancer impacted your job and/or work path?* This field is required.For example: What kind of job do you have? Are you looking for work, and if so, what kind of work are you looking for? Has taking time off for treatment put you behind at work? Because of side effects, do you need to shift to a job that requires new skills? Has your cancer experience made you realize that you want to find more meaningful work in a different company or industry? (NOTE: You will be asked to discuss financial circumstances in a follow-up question.)
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Ok
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How will the information presented at the West Coast Conference help you address some of the issues that you identified in the previous question?* This field is required.For example, how will attending this conference make a difference in your recovery or work? What work & cancer issue(s) do you wish you knew more about? For example: getting a new job; easing interactions with coworkers; understanding legal rights in the workplace; etc.?
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Large
Normal
Small
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Ok
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How many people are in your household including yourself?* This field is required.
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In my household:* This field is required.
I am the only person in my home who provides financially
Other people in my home help financially
Other
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Do you financially support anyone besides yourself?* This field is required.
No
Other
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Are you currently responsible for paying off debt in any of these categories? (select all that apply)* This field is required.
Student
Mortgage
Credit Card
Medical
I am not paying off any debt
Other
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Please provide any additional information on your financial circumstances that will help us understand your eligibility for this award.* This field is required.Things you may want to include (though not required): annual household income, financial burdens, extenuating circumstances, new challenges brought on by COVID-19, etc. We encourage you to provide as much insight as you are comfortable with to help us best understand your current situation.
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Large
Normal
Small
Ok
Ok
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Is there anything else you would like us to consider as we review your application?
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Ok
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How do you prefer to be contacted if you are chosen to receive an award?* This field is required.
Phone
Email
No preference
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How did you hear about the West Coast Conference Technology Assistance Program? (select all that apply)* This field is required.
Healthcare professional (e.g. social worker, nurse, financial navigator, etc.)
Support Group
Friend / family member
Other cancer community organization
Cancer and Careers website
Cancer and Careers email
Cancer and Careers social media post (on Twitter, Facebook, Instagram, LinkedIn)
Cancer and Careers presentation / workshop / event
Social media post from another person or organization
Other
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Have you previously used any of the following Cancer and Careers programs or resources? (select all that apply)* This field is required.
Website
Balancing Work & Cancer Webinars
Virtual Conferences (National, Midwest, West Coast)
In-Person Conferences (New York, Chicago, Los Angeles)
Publications
Resume Review Service
Financial Assistance Grants
Job Search Intensive
Community Events
Technology Assistance Program
None
Other
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Signature

By signing your full name on the following page, you agree to the following statements:

I have read and understand the Terms & Conditions.

The information I provided on this application is complete, accurate and truthful.

If chosen as an award recipient, I will attend the 2025 West Coast Conference on Work and Cancer held online on Saturday, October 25, 2025, from 9 AM - 4 PM (PT).

I am at least 18 years of age, residing in the U.S.

If chosen as a recipient, I will participate in follow-up surveys.
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Signature.Use your mouse curser (if on a desktop computer / laptop) or finger (if using a mobile phone or tablet) to sign your full name in the box below. IMPORTANT NOTE: Then be sure to click "Submit" in the orange bar at the bottom to complete your application.
Clear
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We're sorry. This program is only available to patients/survivors who have been diagnosed with cancer and are not actively pursuing a degree (Associates, Bachelors, Masters, etc.).

Applications received from anyone who has not received a diagnosis, or who is in school for a degree are not be eligible for consideration.

If you are a healthcare, nonprofit and/or HR professional interested in our other programs, opportunities for accreditation or additional grants and resources, please feel free to email Nicole Jarvis, Assistant Director of Programs, at njarvis@cew.org.
Should be Empty:

2025 West Coast Conference Technology Assistance Program - Application

Saving Your Application

Saving (on a desktop computer / laptop)

Saving (on a mobile phone / tablet)

Signature

We're sorry. This program is only available to patients/survivors who have been diagnosed with cancer and are not actively pursuing a degree (Associates, Bachelors, Masters, etc.).

Applications received from anyone who has not received a diagnosis, or who is in school for a degree are not be eligible for consideration.

If you are a healthcare, nonprofit and/or HR professional interested in our other programs, opportunities for accreditation or additional grants and resources, please feel free to email Nicole Jarvis, Assistant Director of Programs, at njarvis@cew.org.