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Cancer and Careers’ Balancing Work & Cancer Webinar Series
Cancer and Careers’ Balancing Work & Cancer Webinar Series
Cancer and Careers’ Balancing Work & Cancer Webinar Series
Name
*
First
Last
Email
*
Company
Phone
*
Mailing address 1
*
Mailing address 2
City
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State
*
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
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
OUTSIDE OF U.S.
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):
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Are you planning to request CEUs for attending?
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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?
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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)?
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Under 18
18-25
26-40
41-50
51-60
61-70
Over 70
Are you/your patients:
*
Please select appropriate answer
Female
Male
Both
Prefer not to answer
Industry
*
Please select appropriate answer
Accounting/finance
Beauty/Fashion/Entertainment
Education/Teaching
Food/Beverage/Hospitality
Healthcare
Human Resources
Insurance/Legal
IT/Computer/Engineer
Non-profit/Government
Other
Publishing/Writing
Retail
Self-employed/Consultant
Unemployed
Employment status:
*
Please select appropriate answer
Employed full-time
Employed part-time
Looking for full-time work
Looking for part-time work
Neither working nor looking for work currently
Self-employed
Retired
N/A
Did you work during treatment?
*
Please select appropriate answer
Yes
No
N/A
How many of your patients work through treatment or return to work soon after?
*
Please select appropriate answer
Most
Half
Some
None
N/A
What is/was your/your patients’ biggest concern about returning to work?
*
Please select appropriate answer
Being discriminated against
Being fired/losing my job
Being overwhelmed with work
Being seen as weak or incapable
Coworkers thinking I am getting special treatment
Needing support and accommodations
Side effects like fatigue and memory loss
Other - If selected, please fill in next answer
If you answered “Other” above, please explain.
*
What is/was your/your patients’ biggest concern about looking for work?
*
Please select appropriate answer
Being discriminated against
Being seen as a cancer patient
Having to explain the gap(s) on my resume
How/if to address my cancer in an interview
All of the above
Not concerned about looking for work
Other - If selected, please fill in next answer
Other - If selected, please fill in next answer
*
Have you ever sought legal advice for a workplace related issue?
*
Please select appropriate answer
Yes
No
N/A
Which of the following programs and services would be most valuable to you/your patients?
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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 appropriate answer
Email from Cancer and Careers
Postcard/flyer from Cancer and Careers
Cancer and Careers’ website
Cancer and Careers representative
Triage Cancer representative
Medical facility/cancer center/physician/doctor’s office
Facebook/Twitter
Google Search or Google Ad
LinkedIn
Word of mouth
Other
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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