Participation Forms

To participate in the program, first contact Executive Director Deb Jensen at 847.491.1122 x19 to learn more about how it works, determine eligibility and share your areas of needs and interest. You must have a preliminary meeting with Deb before entering the program.

Then, complete each of the Participation Forms below. This data provides us with contact information, helps us assess program goals, and assists us in future efforts to obtain funding.

 

 

 

 

 

 

 
“Cancer survivors have so many issues to address physically that the mind/body/spirit connection is often ignored or at the bottom of the list. Finances and energy run thin. This program helps address these issues so well.”

-program participant