Hopeful Hearts - Peer Mentor Inquiry Form

Please use the form below to tell us more about your experience caring for your child through their cancer treatment. To ensure our mentors are well‑positioned to support others, we currently consider applicants whose children have been out of treatment for one year or longer. If eligible, a member of our team will reach out with next steps.

We are grateful for your desire to give back as a Cancer Hope Network Hopeful Hearts Peer Mentor.
All information provided below is kept strictly confidential and will not be shared with anyone outside of Cancer Hope Network.

Tell us about yourself...

First Name *

Last Name *

Email *

Phone *

Location *

How did you hear about/were referred to us? *

Languages spoken *

Child's Current Status

**At this time, only parents whose children have been out of treatment for at least one year are eligible to serve as peer mentors.

Child's Cancer Diagnosis

Please tell us about your cancer experience with your child and why you are looking to volunteer? *