The Leukemia & Lymphoma Society Patient & Community Outreach Volunteer Application

Please answer questions as accurately as possible.

*You must be 18 years of age, or older, to apply for these volunteer positions.

First Name *

Last Name *

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

Phone Number with Area Code *

Phone Type: *

Secondary Phone (if applicable)

Secondary Phone Type:

Email Address *

Date of Birth (format MM/DD/YYYY) * 🛈

Gender *

Male

Female

Other

Your Race? *

Are you Hispanic or Latino? *

Primary language spoken: *

Other languages spoken:

I am available (check all that apply): *

Why are you interested in volunteering with LLS? *

0/250 characters

The following section will help determine what volunteer roles would be the best fit for you and LLS. Please check the skills or tasks that you have experience in or would be interested in helping with: *

If other:

Some Patient & Community Outreach volunteer roles will require a background check. If required, will you agree to provide the necessary personal information to complete the background check? *

Yes

No

Honored Hero: An Honored Hero is a dedicated individual or family who serves as inspiration and provides support to The Leukemia & Lymphoma Society in a variety of ways. An Honored Hero is anyone who has been affected by a blood cancer. As an Honored Hero/Family your story of strength and courage will be shared with participants and donors to provide motivation and encouragement to their money-raising efforts.

I would like more information

LLS relies on fundraising campaigns to support our mission activities. Are you interested in finding out more about fundraising opportunities or volunteering at our fundraising events? *

Yes

No

I am interested in more information about volunteering and/or fundraising for: *

Light the Night: Every fall, friends, families, and co-workers form fundraising walk teams to participate in an inspirational and memorable evening. Walkers carry illuminated lanterns on a 1 - 2 mile walk.

Man & Woman of the Year: A spirited fundraising competition in which participants build fundraising teams to compete for the title of Man or Woman of the Year. This ten-week campaign culminates in a grand finale in which the man and woman in each community who raises the most funds are named Man and Woman of the Year.

Student of the Year: High school students participate in a six-week fundraising competition to benefit The Leukemia & Lymphoma Society. Candidates raise money in honor of a teen patient hero who is currently battling or is in remission from a blood cancer. The candidate who raises the most money at the end of the six weeks is named the Student of the Year.

Team in Training: The flagship fundraising program for LLS and the only endurance sports training program for charity that raises money for blood cancer research. Our coaches will train you to cross the finish line at a marathon, half marathon, cycling event, triathlon or hike adventure.

Other campaign events that may be available in your chapter.

I am a: *

Disease Category (if patient):

Diagnosis:

If Diagnosis is Other, please explain:

Diagnosis Subtype (please type):

Date of Diagnosis - (format 00/00/0000)

Treating Physician(s):

Place(s) of Treatment - (hospital/clinic name):

Treatment you received (check all that apply):

Provide details of treatment here including names of drugs:

When did treatment begin (format 00/00/0000)?

When did treatment end (format 00/00/0000)? If treatment is ongoing, type NA.

Administrative skills (copying, scanning, sorting, mailings)	Coordinating volunteers
Database management	Data entry
Dropping off materials to local treatment centers	Event management
Event support	Experience with Salesforce
Graphic design	Interviewing
Information technology	Leadership
Marketing	Meeting with healthcare professionals
Mentoring	Microsoft Office proficiency
Organizational skills	Project management
Public speaking to large groups	Public speaking to small groups
Recognition and appreciation activities	Representing LLS at health fairs
Social media	Peer to Peer Phone Support
Talking on the phone to patients and family members	Written communication (writing, editing, etc.)
Public Policy/Advocacy	Other