Cancer and Careers’ Balancing Work & Cancer Webinar Series

Name*
First Last
Email*
Company
Phone*
Mailing address 1*
Mailing address 2
City*
State*
Postal Code*
I am*
check all that apply
- Cancer survivor, just diagnosed
- Cancer survivor, currently in treatment
- Cancer survivor, post-treatment
- Social Worker
- Oncology Nurse
- Patient Navigator
- Nurse Navigator
- Nonprofit Professional
- HR Professional
- Manager
- Advocate
- Caregiver
- Other (please specify):
Other (please specify):*
Are you planning to request CEUs for attending?*
- Yes, from NASW
- Yes, from the New York State Education Department Board for Social Work (NYSED)
- Yes, from the American Nurses Credentialing Center (ANCC)
- Yes, from the California Board of Registered Nursing (CABRN)
- Yes, from the Society for Human Resources (SHRM)
- Yes, a general certificate of participation (No CEUs)
- No
What is your professional license number?*
If you do not have one, write N/A
What type of cancer(s) do/did you/your patients have?*
select all that apply.
- Breast
- Blood
- Genitourinary
- Gynecologic
- Skin
- Musculoskeletal
- Colorectal
- Neurologic
- Endocrine
- Respiratory
- All tumor types
- Other (please specify)
Other (please specify)*
Please write N/A if this is not applicable.
16. What age range do you/your patients fall in (select all that apply)?*
- Under 18
- 18-25
- 26-40
- 41-50
- 51-60
- 61-70
- Over 70
Are you/your patients:*
Industry*
Employment status:*
Did you work during treatment?*
How many of your patients work through treatment or return to work soon after?*
What is/was your/your patients’ biggest concern about returning to work?*
If you answered “Other” above, please explain.*
What is/was your/your patients’ biggest concern about looking for work?*
Other - If selected, please fill in next answer*
Have you ever sought legal advice for a workplace related issue?*
Which of the following programs and services would be most valuable to you/your patients?*
- Financial planning assistance
- Pro bono legal services
- Cover letter review
- Resume writing service
- One-on-one career coaching sessions
- One-on-one support to create plans or disclosure conversations with employers/coworkers
- One-one-one support to create plans for working through treatment
- One-on-one support to create plans for returning to their job after time off
- Health insurance navigation tools
How did you hear about this webinar series?*
Please select the webinars you wish to register for. If you would like to register for the full series, please select the All Sessions option.*
- All Sessions
- Managing Long-Term Stress: Wednesday, January 29, 2020 at 1:00 PM EST
- Job Search: Wednesday, February 26, 2020 at 1:00 PM EST
- Career Change: Wednesday, March 11, 2020 at 6:00 PM EST
- Disclosure, Privacy & Online Brand: Wednesday, April 8, 2020 at 6:00PM EST
- Working Through Treatment: Wednesday, May 6, 2020 at 6:00 PM EST
- Occupational Therapy and Vocational Rehab: Wednesday, June 3, 2020 at 6:00 PM EST
- Enhancing Your Skills: Prepping for Success: Wednesday, July 8, 2020 at 1:00 PM EST
- Body Confidence, Self-Confidence in the Workplace: Wednesday, August 5, 2020 at 1:00 PM EST
- Setting Boundaries: Wednesday, September 9, 2020 at 1:00PM EST
- Newly Diagnosed: Getting Started: Wednesday, October 7th, 2020 at 1:00 PM EST
- Health Insurance Options: Wednesday, November 4, 2020 at 6:00 PM EST
- Effective Communication: Tips & Techniques: Wednesday, December 9, 2020 at 1:00 PM EST
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