CSC Collaboration, Vendor, Sponsorship Request Form

Date of Request

mm/dd/yyyy

Organization Name

Organization Description

Organization Web Address

Location of Organization's Service Area

This organization is a 5013c nonprofit.

Contact First and Last Name

Contact Title

Contact Email

Type of Request

Request Description & Timeline

How will your request align with CSC’s mission?

Describe how this request benefit patients, caregivers and families impacted by cancer.

Does the request involve payment or compensation?

Select all that apply.

Is there a cost to CSC with this request?

Does the request include a new grant application involving CSC?

Does this project require IRB (Institutional Review Board) approval?

Please upload supporting documents and sample work.

REQUIRED for projects with IRB approval: study consent, protocol & IRB approval letter or project proposal & approval timeline

Drop your files here

Have you worked previously with Cancer Support Community or Gilda’s Club?

Have you worked previously with other patient advocacy organizations?

Thank you for your submission.

A staff member from CSC will reach out to you within 14 days with next steps.

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