RISE Legacy Application

Please fill out this form in its entirety. Your information will remain private. Your information may be used for internal reporting and/or in materials relevant to the RISE program, but will never be identifiable to any one individual.

Contact Information












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Personal Information



Format MM/DD/YYYY
*In order to participate in the RISE program, you must have at some point been diagnosed with breast cancer.

Format MM/DD/YYYY





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Relevant Experience





Please indicate if the organization was related to breast cancer.





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Acknowledgment of Terms & Conditions
Please read these Terms and Conditions carefully before completing your application for Young Survival Coalition’s (YSC) RISE Program. Your designation is conditioned on your acceptance of and compliance with these terms.

1. I understand that completing this application does not guarantee my designation as a member of the RISE program.
2. I understand that I MUST be a young woman diagnosed with breast cancer in order to qualify for participation in the RISE program. (YSC defines a young woman diagnosed with breast cancer as a woman initially diagnosed with breast cancer before her 41st birthday.)
3. I understand that in order for my application to be considered I must complete all sections and provide all information requested.
4. I understand that any prior or current affiliation with YSC does not guarantee my request to be a designated member of the RISE program.
5. I understand that all information provided to YSC is property of YSC.
6. I have read and agree to the Young Survival Coalition Volunteer Release.
7. I believe that I have completed most or all of the training currently offered by the RISE program and hereby request that I be designated a YSC RISE advocate and kept apprised of future advocacy opportunities.