Test page - CURE Childhood Cancer

Name*

First Last

Address*

Street Address City State ZIP Code

School*

Grade in school as of August 2024*

Junior
Senior

Cell Phone*

Email*

Parent or Guardian contact information and recognition of request to participate

Name*

First Last

Address*

Street Address City State ZIP Code

Phone*

Email*

Were you a part of CURE Crew last year?

Yes
No

Reference contact information (list 2: teacher, coach, work supervisor, minister, etc.) Please note that we do check these references. So select people who you feel will provide a reference on your behalf. Please also let your references know that CURE will contact them via email with a reference request form.

Reference 1 Name*

First Last

Affiliation/Relationship*

Phone*

Email*

Reference 2 Name*

First Last

Affiliation/Relationship*

Email*

Phone*

Will you be fulfilling service hours at your school through the CURE Crew?*

Yes
No

Please list any significant community service experience (include organization name, contact name and number, and a description of the service you performed:*

Please list community service experience.

Organization/agency	Contact name & cell #	Description of Service

Please list school, church or synagogue, sports and/or extra-curricular commitments for fall, winter, and spring:*

Personal Statement

Why are you interested in serving as a member of CURE Crew?*

Why do you think you will be a valuable member of CURE Childhood Cancer's CURE Crew? (Please be specific and provide examples about your experience, skills, and interests.)*

What are three qualities that you think would make you a good representative for CURE in your school and community?*

Do you check and reply to your email?*

Yes
No

What do you hope to gain from your experience as a CURE Crew Member?*

Consent*

By checking this box and submitting the form, I understand that as a member of CURE Crew, I will be representing CURE Childhood Cancer in the community and at school. I agree to adhere to the rules and policies set by my school and understand that if I am expelled from school, criminal charges are brought against me, or I fail to uphold the duties of CURE Crew, membership may be revoked by CURE's Vice President prior to the end of the service term.