Cancer Connect Volunteer Application

The information requested in this form offers you an opportunity to reflect on your reasons for wishing to become a volunteer with the Cancer Connect program

  • Please read the form and make sure you have all of the information ready before you start filling it out.
  • It should take about an hour to fill in the form. You won't be able to save and come back later so you'll need to fill it out in one go.
  • Please contact the Cancer Connect Manager on 03 9514 6315 if you need any help or have any questions about this form.

Please attach documentation to verify cancer diagnosis (i.e. doctor's letter or report)

Contact details

Please mark the most appropriate response to the following questions








Your diagnosis and treatment summary (please complete to the best of your knowledge)

Please tick the type of treatment(s) you have had and provide further details on treatment type:

Further information


Please note all successful applicants will be subject to a Police Check

Cancer Council Victoria collects your personal information to communicate with you about this program, and for program evaluation and reporting. We don't share your information with any other parties. If you don't provide this information you may not be able to participate in the program. You can ask us to stop sending you communications at any time by email to cancer.connect@cancervic.org.au

Our Privacy Policy is available on our website at www.cancervic.org.au or by calling 13 11 20. It explains how we handle your personal information, including how to request access to and correction of your information, how to make a privacy complaint, and our complaint processes.

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