Hope Connections for Cancer Support gathers information about every member of our community so that we can provide the highest quality programs. All programs are provided FREE of cost. Hope Connections is a non-profit organization that relies solely on donations to underwrite our programs and so require the following information to help us secure funding.

All personal information will be kept confidential.

The information provided to funders will be only in terms of combined demographic data of all participants with no identifying information.

  • Your data is kept confidential at Hope Connections. Your information will never be sold or shared with a third party.
  • MM slash DD slash YYYY
  • Personal & Contact Information

  • About

    Please complete the following for yourself or for the person you are here to support.
  • MM slash DD slash YYYY
  • Additional Information

    Please note: Attendance at an orientation is required before attending Support Groups and Mind/Body classes. Unless otherwise noted, all of our programming are for those age 18 and over. Comfortable clothing and physician approval recommended for all exercise Mind/Body Classes.
  • Please write the name of the person who referred you, or n/a if not applicable.
  • Hope Connections reserves the right to refuse to provide services to participants and to allow participants to engage in Hope Connections programs who violate or threaten to violate Hope Connections’ policies, are threatening or disruptive to staff or other participants or who appear to present a potential danger to the participant, staff or other participants.