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Survivorship Series Program Leader application

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Thank you for your interest in the Survivorship Series.

This application will take between 20-30 minutes to complete. The application deadline is Friday, November 14.

For additional information about the program, visit the LBBC Survivorship Series webpage. For more information about this application, as well as eligibility requirements, visit our FAQ. For all other questions, please contact Olive Hope at hcp@lbbc.org.

Please select one of the following responses:(Required)

I am applying as a solo/individual Program Leader

We are applying as a two-person Program Leader team from our cancer center

⚠️ Teams must complete the application together. Only one application should be submitted per team.

Has your cancer center or health system had other healthcare providers trained for the Survivorship Series in the past?(Required)

Unsure

Yes

Please provide the name of the previously trained Program Leader(s):(Required)

What is your cancer center name?(Required)

What is your health system name (if applicable)?

Where do you provide breast cancer care? Check all that apply.(Required)

Academic medical center

Community cancer center

Community hospital

Private practice

Safety net hospital

Tribal health center

Other (please specify)

Unsure

Please specify where you provide breast cancer care:

What best describes the location where your cancer center is located?(Required)

Rural

Urban

Suburban

Other (please specify)

Please specify the location of your cancer center:

Does your cancer center/health system currently offer group sessions or programs for breast cancer patients on survivorship?(Required)

Yes

Unsure

Please read and check the requirements below for participation in the Survivorship Series:(Required)

I have two or more years of experience as an RN-level oncology nurse navigator or oncology nurse.

I work with young breast cancer survivors (diagnosed under age 45).

I am able to fully participate in the live virtual training on January 20, February 10, and February 17, 2026.

I will also be able to view on-demand educational sessions (approximately 3 hours) between January 21 – February 5.

I anticipate being able to implement the four-part series for young breast cancer patients at my cancer center between March – September 2026.

My cancer center is able to provide administrative, marketing, and other logistical support for this program.

I have the time needed, approximately 25-30 hours outside of training, for the Survivorship Series.

I have discussed this opportunity with my supervisor, and they are supportive of my application.

Please read and check the requirements below for participation in the Survivorship Series:(Required)

At least one of our team’s applicants has two or more years of experience as an RN-level oncology nurse navigator or oncology nurse.

We work with young breast cancer survivors (diagnosed under age 45).

We are able to fully participate in the live virtual training on January 20, February 10, and February 17, 2026.

We will also be able to view on-demand educational sessions (approximately 3 hours) between January 21 – February 5.

We anticipate being able to implement the four-part series for young breast cancer patients at our cancer center between March – September 2026.

Our cancer center is able to provide administrative, marketing, and other logistical support for this program.

We have the time needed, approximately 25-30 hours outside of training, for the Survivorship Series.

We have discussed this opportunity with our supervisors, and they are supportive of our application.

Why are you interested in being trained to implement the Survivorship Series? (Required)(Required)

What do you see as the biggest unmet need of the young (diagnosed under age 45) breast cancer patients you see?(Required)

How would you see this educational series enhancing the experience of the young breast cancer patients you work with?(Required)

Please provide your contact information:

Please provide the following information for the first member of your team:

Name(Required)

First Last

Title/position(Required)

Work email address(Required)

Work phone number(Required)

Cell phone number(Required)

City(Required)

State(Required)

ZIP code(Required)

Which of the following best describes your role in patient care?(Required)

Please specify your role in patient care:

Please list your degree/credentials (e.g. RN, BSN). (If none, please enter "none".)(Required)

Have you applied to participate in the Survivorship Series in the past?(Required)

Yes

Unsure

What is your primary area of practice (check all that apply):(Required)

Cancer screening

Surgery

Medical oncology

Radiation oncology

Survivorship clinic

Other (please specify)

Please specify your primary area of practice:

How did you find out about the Survivorship Series? (Check all that apply):(Required)

LBBC email

LBBC staff member

Social media

Previously-trained Survivorship Series Program Leader

Colleague

Professional association (please specify)

Another cancer organization (please specify)

Unsure

Other (please specify)

Please specify which professional association:

Please specify which cancer organization:

Please specify how you found out about the Survivorship Series:

The next 4 questions are optional. This section asks for some general demographic information about you so that we can understand how different groups use our programs and services to make our efforts better for everyone.

Which of the following best describes your race?

Asian

Native Hawaiian/Pacific Islander

Black/African American

Native American/American Indian/Indigenous

White/Caucasian

Two or more races

Prefer not to share

Other (please specify)

Please specify your race:

Do you consider yourself to be of Hispanic, Latino, or Spanish origin?

Yes

Prefer not to share

The next two questions are for use in this application only and will not otherwise be recorded, stored, or shared externally. As a reminder, these questions are also optional.

What is your gender?

Male

Female

Gender Non-Conforming

Other (please specify)

Please specify your gender:

Are there any aspects of your identity that are important for us to know?

Please provide the following information for the second member of your team:

Name(Required)

First Last

Title/position(Required)

Work email address(Required)

Work phone number(Required)

Cell phone number(Required)

City(Required)

State(Required)

ZIP code(Required)

Which of the following best describes your role in patient care?(Required)

Please specify your role in patient care:(Required)

Please list your degree/credentials (e.g. RN, BSN). (If none, please enter "none".)(Required)

Have you applied to participate in the Survivorship Series in the past?(Required)

Yes

Unsure

What is your primary area of practice (check all that apply):(Required)

Cancer screening

Surgery

Medical oncology

Radiation oncology

Survivorship clinic

Other (please specify)

Please specify your primary area of practice:(Required)

How did you find out about the Survivorship Series? (Check all that apply):(Required)

LBBC email

LBBC staff member

Social media

Previously-trained Survivorship Series Program Leader

Colleague

Professional association (please specify)

Another cancer organization (please specify)

Unsure

Other (please specify)

Please specify which professional association:

Please specify which cancer organization:

Please specify how you found out about the Survivorship Series:

Which of the following best describes your race?

Asian

Native Hawaiian/Pacific Islander

Black/African American

Native American/American Indian/Indigenous

White/Caucasian

Two or more races

Prefer not to share

Other (please specify)

Please specify your race:

Do you consider yourself to be of Hispanic, Latino, or Spanish origin?

Yes

Prefer not to share

The next two questions are for use in this application only and will not otherwise be recorded, stored, or shared externally. As a reminder, these questions are also optional.

What is your gender?

Male

Female

Gender Non-Conforming

Other (please specify)

Please specify your gender:

Are there any aspects of your identity that are important for us to know?

Survivorship Series Program Leader application

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