National Breast Cancer Coalition

Get On The Clock

2018 Project LEAD Institute & Scholarship Application

 

Contact Information

1. Required fields are marked with a *

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Name:

 

 

 

 

     

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City/State/ZIP:

 

    

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If you respond and have not already registered, you will receive periodic updates and communications from National Breast Cancer Coalition.

 

 

What's this?

*2.
Question - Required - What is your educational background?






*3.  


*4.
Question - Required - Are you currently a member of NBCC? NBCC membership is required for your application to be considered. If you are not a current member of NBCC, join by April 18, 2018.


*5.
Question - Required - What is your connection to breast cancer?








*6.

(Maximum response 255 chars, approx. 5 rows of text)

 

Breast Cancer Organization Affiliation

*7.

*8. What best describes the focus of the organization?
(Select one of the available choices or enter a different value.)



*9. What best describes the scope of the organization?
(Select one of the available choices or enter a different value.)



*10. What is the size of the organization?
(Select one of the available choices or enter a different value.)



*11.
Question - Required - What best describes your role in the organization?







 

Prior involvement with NBCC

*12.
Question - Required - Please check all events that describe your prior involvement with NBCC:

*13.
Question - Required - How did you hear about the Project LEAD® Institute?









 

Optional Demographic Information

14.
Question - Not Required - What is your birthdate?




15.


16.
Question - Not Required - How would you identify your race/ethnicity?

 

Essay/Application Questions

 

Please answer the following questions thoughfully. These responses are a critical part of the selection process for acceptance as a Project LEAD® participant. This competitive process enables us to choose students who desire to have a leadership role in Breast Cancer Deadline 2020® as there are a limited number of spaces available. You have room for 250 words for each question.

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*20.

 

Scholarship Questions

Please respond to the following questions using a minimum of 150 words. Your answer to these questions is mandatory in order to complete the scholarship application process.

*21.
Question - Required - Have you ever received a scholarship from NBCC?


   
*22.

   
*23.

   
*24.
Question - Required - Since scholarship funds are limited, which form of assistance do you require? Please note, lodging scholarship recipients are required to share a room with another scholarship recipient.




*25.

   Please leave this field empty

     

 
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